EVIDENCE-BASED CHIROPRACTIC CLINICS are becoming the new norm. A traditional doctor of chiropractic (DC) may consider his or her own expertise and patient preferences, but an evidence-based chiropractic physician ties in the latest research on a condition when evaluating, diagnosing and treating a patient.
Ronald Farabaugh, DC, owner of a Columbus, Ohio, clinic, teaches seminars on evidence-based practices in his self-created Chiropractic Bootcamp Seminars. “An evidence-based practice (EBP) is a practice that proactively is informed of evidence and makes clinical decisions based on the evidence,” he says. But evidence-based chiropractic physicians won’t exclusively rely on research; they will also take into account clinical experience and patient preferences.
Many DCs were previously taught to base their treatment recommendations on philosophy, and not so much on research, Dr. Farabaugh explains. However in the past decade, many of the colleges and universities have certainly improved educational standards related to research and for that they should be applauded.
Evidence-Based Practice Education
The trend is for chiropractic colleges to increasingly incorporate evidence into teaching. Palmer Chiropractic College, for example, is one chiropractic college that has taken the initiative to implement evidence-based philosophies into its doctor of chiropractic curriculum. In 2007, Palmer was awarded a grant by the National Institutes of Health (NIH) to accomplish exactly this.(1)
“We now have classes devoted to evidence-based clinical practice (EBCP), and the concept is weaved into most courses,” says Michael Tunning, DC, an assistant professor in the diagnosis and radiology department at Palmer College of Chiropractic’s Davenport campus since 2008. This fall, Palmer will be teaming with University of Iowa for its 8th EBCP workshop retreat for Palmer faculty development in EBCP principles, practice and teaching.
Similar to Palmer, National University of Health Sciences has been implementing evidence-based courses into its curriculum for almost a decade, triggered by the acquisition of the same NIH grant in 2005. The funding provides all professional degree students with training and experience in evaluating current research and applying it to more effective strategies for patient care.(2) University of Western States and Northwestern Health Sciences University have also received grants on this same initiative, in 2005 and 2007 respectively.
Benefits of Using Evidence
“Research is necessary to make sure that chiropractic is positioned well in this outcomes-based world,” says Dr. Farabaugh. “Research is a great way to show how chiropractic gets a better result with less money and therefore informs the public of its cost-effectiveness, leading to more cooperation and the expansion of chiropractic in the marketplace.”
Dr. Farabaugh explains that chiropractic research is important in educating three specific parties: other medical professionals, patients and the business community. Research can educate other medical professionals about the benefits of chiropractic and potentially lead to medical referrals from these doctors.
DCs are well received by patients when they show that their technique is backed up by evidence. “Patients like when a DC is current,” says Dr. Farabaugh. In addition, the more chiropractic research exists, the likelier the business community (i.e., large self-insured companies, work-compensation programs) will seek out chiropractic for their employees. “I also think we should be educating the employers,” he says.
When insurance is involved, Dr. Farabaugh finds it pertinent to be up to date on the latest chiropractic research for various situations, such as when independent medical examiners deny chiropractic claims. DCs should find the most recent evidence and submit an appeal. “The more DCs are astute in chiropractic research, the more likely they can use it to get paid,” he says.
He also finds that research can attract the legal profession. Demonstrating the benefits of chiropractic for personal injury patients could encourage the legal profession to refer these patients to DCs.
Dr. Farabaugh’s favorite resources are the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), of which he was the chairman, Topics in Integrative Health Care (http://www.tihcij.com) and the Journal of Manipulative and Physiological Therapeutics. In addition, “All DCs should get familiar with PubMed,” he says. “Read the abstracts, or order the paper and drill deeper if you want.” DCs should work to improve their critical thinking skills, in both reading and dissecting research. [For more on CCGPP, see May 2014 ACA News, Page 10; for more on JMPT, an ACA member benefit, see Sept. 2015 ACA News, Page 4.]
“The CCGPP was created by the Congress of Chiropractic State Associations (COCSA) upon realizing that evidence-based medicine was here to stay,” says Dr. Farabaugh. “The CCGPP’s mission is to provide consistent and widely adopted chiropractic practice information, to perpetually distribute and update this data, as is necessary, so that consumers and others have reliable information on which to base informed health care decisions,” according to its website.3
Dr. Farabaugh explains that the guidelines are based on the systematic review of the literature on particular topics. These topics include, but not are limited to, cervical, thoracic and lumbar spines; upper and lower extremity; special populations; wellness; geriatrics; pediatrics; and others.
Dr. Tunning empathizes with DCs who have difficulty finding open-access journals, but suggests that DCs refer to Palmer’s Evidence-Based Clinical Practice (EBCP) Resources on the college’s website, which includes a lot of free and high-quality research. (See sidebar.) He also agrees with Dr. Farabaugh in that becoming familiar with PubMed is important.
In the neuromusculoskeletal diagnosis-based course he teaches, DynaMed is his go-to resource for his students in building their foundational knowledge. Critical thinking skills are a big part of this. Having the ability to ask questions and incorporate evidence into a patient’s case is pertinent for creating a successful evidence-based chiropractic practice.
Another Option for Established DCs
As the founder and host of Chiropractic Bootcamp Seminars, Dr. Farabaugh discusses several topics over a period of six to twelve hours. These topics have included spine and extremity guidelines, case management and risk management/malpractice, with each topic based on evidence and infused with research that all DCs can use.
The American Chiropractic Association hosts webinars [free to members] for continuing education units that often have discussions of current literature supporting the diagnosis and treatment of various conditions. ACA’s annual National Chiropractic Leadership Conference (NCLC) is another opportunity for DCs to learn about evidence-based practices, the most up-to-date chiropractic literature and how to apply it when with a patient. NCLC 2015 included seminars on the evidence-based treatment protocol for metabolic X syndrome, evidence-based practice in a community health center and the evidence-informed chiropractic practice in 21st century health care, among many others.
“Evidence is going to inform the future of health care, so it’s important that we become proficient in EBP as a profession,” says Dr. Tunning. “It will drive the future of the [chiropractic] profession.”
• Each month in ACA News, JACA Pages: Evidence In Action, discusses an important research topic. In a special column titled “Evidence-Based Resources,” ACA News Publications Board Chairman Dana Lawrence, DC, MMedEd, MA, listed the best sources for research evidence for the chiropractic physician. Visit June/July 2015 ACA News, Page 32 at http://mydigimag.rrd.com/publication/?i=260575.
• Palmer College of Chiropractic provides the public with many evidence-based clinical practice resources. Guidelines, systematic reviews, search engines, journals to know and relevant ACA News articles are among the many resources compiled for you to use. Visit www.palmer.edu/research/ebcp-resources
• McMaster University hosts evidence-based clinical practice workshops for clinicians who wish to improve their clinical thinking skills, in reading, interpreting and applying evidence in their practices. Visit http://ebm.mcmaster.ca/about_intro.htm to learn more.
• Evidence-based practice training program created by NWHSU and the University of Minnesota available at:www.csh.umn.edu/evidenceinformedpracticemodules.
• Chiropractic & Manual Therapies also has free full-text research papers online at www.chiromt.com.
• WFCSuggestedReadingList.com offers great resources, too.