Chiropractors’ Research Priorities

Chiropractors around the world have recently formed a seminal list of priorities for research. Instigated by Bruce Walker on the chiro-sci email discussion group, the following list has been formulated. The list is reproduced here to encourage debate about research priorities and serve as a resource for researchers and supervisors. It is intended that the list be refined with time.

Basic science and epidemiology:

• Neurophysiological efffects of SMT on the brain
• Magnitude of spine pain problems
• The natural history of spine pain
• What are the pain generators in the spine and how to identify them
• Documenting a normal spine and pelvis!
• What is joint dysfunction?
• Do spinal joints lose their joint play? If so, are there neurological effects? What are they?
• What is muscle dysfunction? Do muscles become “hypertonic” in humans? What are the neurological effects, if any? Does this dysfunction become widespread? How?
• Why do some patients with a certain clinical condition, ie disc herniation, have severe pain whereas others have no pain at all?
• What is spinal stability? What is spinal instability?
• Research relating to the components and control of posture - ie, what is muscle tone; what components are active and what are passive?
• Research on a ‘unifying’ model of spinal function, relating movement, posture and system control (ie effects of various mechanoreceptors) with dysfunction /pain syndromes.
• When is a short leg significant?
• Do osseous spinal anomalies pre-dispose to pain?

Diagnosis:

• Identifying subsets of spine pain patients that may respond to differing therapies
• Reliability and validity of all tests commonly used for spinal diagnosis
• SI joint diagnosis
• Does subluxation exist and if so how can it be measured
• Reliable and valid testing procedures for nervous system function.
• How can we definitively identify the most important features in a patient’s clinical condition?
• Can we reliably identify pain generating tissues?
• Can we reliably identify faulty movement patterns? Instability? Do we even need to? Does “bad” posture play a role in the perpetuation of spinal pain syndromes?
• If a patient has a centralised lumbosacral junction ‘ache’, can we identify if it is discal, muscular, ligamentous, etc?
• Distinguishing between neurological and orthopedic (mechanical) spinal analysis tests and their relationship to common analytic protocols used in practice
• How to identify a cervicogenic headache

Therapy:

• Cohort studies to examine possible short and long term benefits and/or harms associated with maintenance care
• An RCT comparing SOT, AK and Activator for spine pain
• An RCT comparing SOT, AK, Activator and placebo for spine pain
• An RCT comparing SMT, massage therapy and SMT with massage therapy
• SI joint treatment effectiveness
• When is SMT most appropriate, what form is most appropriate for which patient and how much manipulation and what adjuncts should be used?
• RCT comparing SMT vs. SMT + NSAID vs. NSAID for neck and back pain.
• Chronic back pain management using functional restoration with a DC on the team
• Identifying the psychological aspects of chronic pain and their management
• Comparing the cost effectiveness of various treatments
• How can we identify those combinations of treatments that are most effective in certain clinical situations?
• Comparing thrusting and non-thrusting manipulative techniques.
• Comparing various “named” techniques
• Should manipulation be instituted before exercise? Would this be different for stabilisation exercise vs. sensorimotor training vs strength training vs. postural training? Does spinal stabilisation really improve spinal stability?
• An RCT comparing heat and cold application in acute spine pain

Harm:

• Cervical artery damage prevention
• When not to use SMT
• Can a spine be over-manipulated? If so, at what point?
• Can we identify those at risk for vertebrobasilar dissection?
• Can manipulation cause a herniated disc? In the L spine? In the C spine? T spine?
• Does the SI joint become unstable and can this be corrected?

Prevention:

• Can chiropractors assist in the prevention of osteoporosis? Program development, implementation and outcome testing.
• Vaccine preventable diseases, how the chiropractor can assist in the promotion of immunisation? A pilot study on effectiveness?