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Summer 2009


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.
William and Jo Harris building

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.

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