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What is Evidence-Based Clinical Practice?

What is Evidence-Based Clinical Practice?

Palmer's strategy for focused curricular change to improve patient care
Fall 2011

Palmer College

An update on Palmer’s efforts to help integrate chiropractic into the U.S. military

Since President George H.W. Bush signed the authorization on Oct. 23, 1992 to commission D.C.s in the United States military, incremental progress has been made in bringing chiropractic fully into the U.S. military as well as Veterans Affairs healthcare facilities. But many in the chiropractic profession would say that this progress has been too slow and that all active-duty troops and veterans should have access to chiropractic. Palmer College is taking the lead on several fronts to bring chiropractic more fully into the U.S. military—for active-duty troops as well as veterans and their families.

DOD research project

In February 2011, scientists at the Palmer Center for Chiropractic Research (PCCR), the RAND Corporation and the Samueli Institute were awarded a landmark $7.4 million grant by the Department of Defense (DOD) office of Congressionally Directed Medical Research Programs. The grant is funding a four-year research project to assess chiropractic treatment for military readiness in active-duty personnel. This is the largest single award for a chiropractic research project in the history of the profession.

Ian Coulter, Ph.D., the Samueli Institute Chair in Policy for Integrative Medicine at RAND Corporation, is the research project’s principal investigator. Co-principal investigator and Palmer College of Chiropractic’s Vice Chancellor for Research and Health Policy Christine Goertz, D.C., Ph.D., is overseeing the design and implementation of the three clinical trials funded by this award. The PCCR will receive approximately $5.1 million in order to accomplish this task. Samueli Institute Vice President for Military Medical Research Joan Walter, J.D., also is a co-principal investigator for this project.

Katie Pohlman, D.C., M.S., is serving as the PCCR’s clinical project manager for the project. She supervises all of the project managers for the three clinical trials and handles the complex logistics and day-to-day operations of the huge study, which is being conducted by a team of nearly 40 people at the three institutions and a total of six military sites for all of the trials.

This comprehensive project will assess the efficacy of chiropractic treatment in the following areas: relieving low back pain and improving function in active-duty service members; evaluating the effects of chiropractic treatment on reflexes and reaction times for Special Operations forces; determining the effect of chiropractic treatment on strength, balance and injury prevention for members of the Armed Forces with combat specialties; and assessing the impact of a chiropractic intervention on smoking cessation in military service members.

The first clinical trial, known as Assessment of Chiropractic Treatment I, or ACT I, will examine chiropractic’s effectiveness in relieving low back pain and improving function in active-duty service members at military facilities located in Pensacola, Fla., Bethesda, Md., Rock Island, Ill., and San Diego, Calif. “The doctors of chiropractic who will be delivering the care in this study are those who are already treating patients on base at these four facilities,” said Dr. Goertz. “It is important to work with D.C.s who are already integrated into the healthcare system at the bases.”

Data collection for ACT I will begin in 2012.
chiropractor is writing on clipboard while talking to military patient

Since February, Drs. Goertz and Pohlman have been busy working with the rest of the team to create the many data collection forms needed for ACT I. “The baseline patient interview form and informational video, along with 10 to 15 sets of online questionnaires for each patient at weeks two, four and six, and at three months, have been developed and are ready for the study to begin,” said Dr. Pohlman. The plan is for data collection to begin at the Pensacola, Fla., and Bethesda, Md., sites by early next year, with the Rock Island, Ill., and San Diego, Calif., sites beginning collection later in 2012.

In addition to the creation of the data collection forms, the team has been working to secure approvals from the Institutional Review Boards (IRBs) from the collaborating research institutions as well as all of the military sites. So far, the project has received IRB approval from the PCCR and RAND Corporation, and at the time this article was being prepared in September 2011, IRB approval from the military sites for the first clinical trial had been requested but not yet awarded.

The study team is receiving guidance and oversight from a number of other committees and boards, including an 11-member Expert Advisory Board, Palmer’s Data Safety Monitoring Committee and an internal steering committee. Both the Data Safety Monitoring Committee and the Expert Advisory Board include research experts from outside Palmer, RAND and Samueli.

Of course, planning work on the other two clinical trials must be conducted simultaneously with work on the first one. “We will have completed protocols for ACT II and III by the end of 2011,” Dr. Goertz said. “We are working hard to develop study details for these two additional studies at the same time that we get ready to launch ACT I.”

Palmer teams up with VA to provide veterans with up to one year of tuition

Through a unique program offered by the U.S. Department of Veterans Affairs (VA), Palmer College is making it possible for eligible U.S. veterans enrolled or about to enroll at any of Palmer’s three campuses to have up to 100 percent of their out-of-pocket tuition and fees covered for a one-year period. Known as the Yellow Ribbon GI Education Enhancement Program, or Yellow Ribbon Program for short, the plan covers undergraduate and graduate tuition not already provided for by the Post-9/11 Veterans Educational Assistance Act of 2008.

ribbon symbol

The Yellow Ribbon Program allows U.S. degree-granting institutions to enter into an agreement with the VA to fund expenses that exceed the highest public in-state undergraduate tuition rate. Each participating institution can contribute up to 50 percent of those expenses, and the VA will match the same amount as the institution. Palmer is contributing at the highest level of 50 percent. Beginning Aug. 1, 2011, qualifying veterans who are current or incoming students at one of Palmer’s campuses began applying to the Yellow Ribbon Program, and those accepted will have their tuition costs covered for one year beginning with the fall 2011 term.

Robert Miller is a fourth trimester student and veteran on the Davenport Campus who has applied and begun receiving funds through the Yellow Ribbon Program. He served in the U.S. Navy as an electronics technician from 1999 to 2004 at Whidbey Island Naval Air Station in Oak Harbor, Wash. After leaving the Navy in 2004 to pursue an undergraduate degree in electronics in Rexberg, Idaho, he worked in the private sector in Idaho and Utah until being laid off in 2009. He had considered a career in chiropractic before going into electronics, and decided with his wife that now was the time for him to pursue it, especially since his Post-9/11 GI Bill benefits would cover 26 more months in college.

“It wasn’t an easy decision to go from what you know to something new,” he said. “I stepped into the dark and the light followed. I would advise people to go for it. For me, this is a huge benefit. It will reduce the amount of debt I’ll graduate with from potentially $80,000 to about $50,000. That will mean a big difference in loan payments and being able to start a practice sooner after graduation.”

Current or prospective Palmer students interested in applying to the Yellow Ribbon Program should contact:

  • Jennifer Stratman, Student Administrative Services, Davenport Campus
    (563) 884-5654
  • Brenda Alvarez, Financial Planning, West Campus
    (408) 944-6023
  • Jaclyn McKay, Student Administrative Services, Florida Campus
    (386) 763-2667
DOD/VA internship program update

The Department of Defense/Veterans Affairs Chiropractic Internship Program provides senior-level interns from all three Palmer campuses with an opportunity to work with a staff chiropractor located in a Department of Defense or Veterans Affairs hospital. The interns gain valuable insights into how the Doctor of Chiropractic works with health professionals from other disciplines for the benefit of the patient.

In the spring of 2011, Palmer College of Chiropractic established academic affiliations with three additional Department of Defense facilities in Rhode Island, Connecticut and California, bringing affiliations with DOD facilities to a total of five. Then in August 2011, an academic affiliation with a Veterans Affairs facility in Augusta, Ga., was established, bringing the total VA facility affiliations to six. Palmer students now have opportunities for internships with 11 different sites. Since the program started in 2007, 43 students from Palmer’s three campuses have completed internships in DOD and VA facilities.

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