Measures in chiropractic research:
Choosing patient-based outcome
assessments
AUTHORS: Raheleh Khorsan, M.A.; Ian D. Coulter, Ph.D.;
Cheryl Hawk, D.C., Ph.D.; and Vice Chancellor for
Research and Health Policy Christine Goertz, D.C., Ph.D.
The William and Jo Harris Building houses the
Palmer Center for Chiropractic Research (PCCR)
on the Davenport Campus. Independent research
studies also are conducted separately on each of
Palmer’s campuses. |
Outcome assessment normally used in research can support the
therapeutic process by tracking patient symptoms and function
and offering a common language to clinicians and researchers.
This study’s objectives were to (1) identify patient-based outcomes
assessments used in published chiropractic studies, (2)
describe a framework for identifying appropriate sets of measures,
and (3) address the challenges associated with these measures
relevant to chiropractic.
This literature review identified and evaluated the most commonly
used outcome measures in chiropractic research. Instruments
were evaluated in terms of feasibility, practicality, economy, reliability,
validity, and responsiveness to clinical change. A search of
PubMed and Index to Chiropractic Literature (from inception to
June 2006) was performed. The most common patient-based
outcomes assessment instruments identified were the Oswestry
Pain/Disability Index, Visual Analog Scale, and Short Form 36.
Those most commonly cited in the literature for use in chiropractic
care are the numeric rating scale, Visual Analog Scale,
Oswestry Pain/Disability Index, Roland-Morris Low Back Pain
and Disability Questionnaire, and Short Form 36.
The full abstract of this study can be read in Journal of
Manipulative Physiological Therapeutics. 2008 Jun;31(5):355-75.
A feasibility study assessing manual
therapies to different regions
of the spine for patients with
subacute or chronic neck pain
AUTHORS: Richard G. Strunk, D.C., M.S. (received
through the Davenport Campus Master of Science
clinical research program); and PCCR Principal
Investigator Maria A. Hondras, D.C., M.P.H.
The purpose of this project was to develop and test protocols
for a randomized clinical trial of a combined therapeutic
approach (thoracic spine and sacroiliac joint high-velocity,
low-amplitude spinal manipulation [HVLA SM] + cervical
spine postisometric relaxation) and cervical spine HVLA SM for
patients with subacute or chronic neck pain. After a baseline
assessment visit, eligible patients were randomly assigned
to cervical spine HVLA SM or to the combined therapeutic
approach for four treatment visits over two weeks. Outcome
assessments included the Neck Disability Index, visual analog
scale, and post-treatment response questionnaire.
Twelve participants were screened, and six patients were enrolled
and randomly allocated to care over a six-week period. All
patients completed five visits. Five of six patients had an
improvement on the Neck Disability Index. On the visual
analog scale, two patients improved at two weeks, whereas the
other four got worse. Five patients completed the post-treatment
response questionnaire; two of the five indicated they
experienced discomfort or an unpleasant reaction from the
study treatments. Patients were willing to be randomized,
follow treatment protocols, complete baseline and outcome
assessments, and return 83% of the follow-up questionnaires.
The full abstract of this study can be read in Journal of
Chiropractic Medicine. 2008;7(1):1-8.
Researchers in bold are graduates and/or faculty members
of Palmer College.