Synopsis:

To address previous problematic areas in research which address the comparative costs of chiropractic and medical care, the Chiropractic Value Statement (CVS) will draw from patient claims through a patient providers' organization in the United States and combine the approaches of both clinical and actuarial science. John Triano, D.C., Ph.D., is to provide the diagnoses for doctors of chiropractic; those for medical care are to be furnished by medical primary care physicians. Both chiropractic and medical costs for the most common musculoskeletal conditions are to be compared, taking into account all ancillary costs associated with referrals, pharmaceuticals, and surgery. Patients who experience chronic musculoskeletal problems and who have been treated recently, as well as those who do not reach a certain level of wellness and have to be seen again shortly after treatment will be excluded by the inclusion of a 60-day clean period. Employing an actuary to assess costs will eliminate a possible source of bias in the data thus retrieved. Use of a PPO rather than workers' compensation is believed to provide a more balanced mix of patients with fewer confounding factors. Finally, data from at least two separate states is to be assessed in hopes of increasing the external validity of the study.

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Synopsis:

This research addresses palpation as the centerpiece of chiropractic evaluation and diagnosis. It proposes to do so by means of a systematic review of the peer-reviewed literature, accounting for the quality of the studies and establishing a standardized method with which to evaluate the current evidence on the reproducibility of spinal palpation. In this study, the MANTIS, Cinahl and MEDLINE databases are to be searched through 2002 for documentation using the index terms “reliability,” “reproducibility,” “observer variation,” “palpation,” “motion palpation,” “physical examination procedures,” and “spine”  alone or in combinations. The bibliographies of the retrieved documents will be searched for additional relevant studies. Two readers are to independently perform the data extraction and quality assessments, assigning a quality score based on predefined methodological criteria to each document. The level of evidence for the reproducibility of palpation will then be able to be determined from these quality scores.

This approach is expected to identify previously unrecognized issues and potential errors in both the design and methodology of the existing literature. It should also identify clear and feasible pathways for future research, including the provision of tools to more thoroughly assess the reproducibility of palpation in future studies.

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Synopsis:

Consent that is based on discussion and dialogue between patient and practitioner—essential for best practice—is the core subject of this investigation. It is clearly a matter of importance since the majority of cases involving litigation with chiropractors in several countries reveal that patient informed consent was not given. This proposed research will survey 1,000 randomly selected registered chiropractors, comparing 500 in the U.S. and 500 in the U.K. Although the proposed numbers are not intended to provide a statistically representative sample of the profession in either country, apparent trends should become evident. Furthermore, samples are to be stratified in terms of geography with representative states from the north, south, east and west of each country.

The questionnaire will identify how members of the profession approach the main elements of consent in addition to containing sociologically based questions and demographic information. Responses requested will be dichotomous; i.e., on a scale of always, sometimes, only if asked, and never. The questionnaire itself has been validated and used previously, presented at several scientific conferences. Responses are to be collected at the National University of Health Sciences and the Institute for Musculoskeletal Research and Clinical Implementation (Anglo-European College of Chiropractic) in the U.S. and U.K., respectively.

Non-responders will be sent a further questionnaire about 3 weeks after the initial mailing. Those who still do not respond will be contacted by telephone 10 days after, followed by a third mailing with a second telephone follow-up to maximize the response rate. Both nominal and ordinal differences between the two groups are to be analyzed by chi-square and Mann-Whitney U tests, respectively.