Where are chiropractic clinical outcomes registries? My colleagues—former American Chiropractic Association (ACA) President Michele Maiers, DC, MPH, PhD; Kent Stuber, DC, MSc, PhD; KatiePohlman, DC, MS, PhD; and Amy Ferguson, MLS —and I recently published a paper exploring this critical question. Our work investigates whether the chiropractic profession is harnessing clinical outcomes registries to advance research, enhance patient care, and inform policy. You can read the full paper for free here.
Why This Research Matters
Imagine facing a medical decision: for a hernia repair, would you choose Dacron mesh or sutures alone? Would you opt for fish oil and curcumin over ibuprofen for inflammation? Or, for persistent cervical radiculopathy, would you consider an artificial disc or cervical discectomy and fusion? These choices hinge on evidence about what works best. Clinical outcomes registries provide a powerful tool for chiropractors to refine treatment approaches by systematically comparing their effectiveness. By collecting patient outcomes—such as pain levels, mobility, or quality of life—over time, registries offer real-world data to guide clinical decisions.
As practitioners, we often assume certain treatment choices make little difference, based on our day-to-day experiences. But what if data revealed that these choices do matter? Conversely, when we agree that treatment plans are critical, registries can confirm which approaches yield the best results. Recent studies have even questioned whether specific chiropractic spinal manipulative techniques matter, citing predominantly low-quality evidence that feels disconnected from clinical reality. Registries help bridge this gap, grounding our understanding in robust, real-world, long-term data to challenge assumptions and elevate care.
Executive Summary of Our Findings
Our scoping review revealed a significant gap in chiropractic-specific clinical outcomes registries. While medical and administrative registries sometimes include chiropractic data, they lack the focus needed to capture the profession’s unique contributions. Developing dedicated chiropractic registries will require visionary leadership, coordinated efforts, and investment in infrastructure to systematically document clinical outcomes. Such registries could transform how chiropractors demonstrate value, improve patient outcomes, and integrate into broader healthcare systems.
The Origin of This Research
As a chiropractor and researcher engaged with the sports medicine community, including the American Orthopaedic Society for Sports Medicine and the University of Colorado’s Orthopedic Sports Medicine Fellowship, I’ve witnessed the transformative power of clinical outcomes registries. In orthopedics, these systems collect longitudinal patient data, enabling clinicians to compare surgical techniques, refine practices, and inform research. This approach has become a cornerstone of evidence-based care, inspiring me to ask: is chiropractic doing the same?
To explore this, I connected with a valued colleague, the former ACA president, who had supported me by attending my PhD thesis defense virtually during the pandemic. Our conversation sparked a collaboration with a talented research team, including Drs. Maiers, Stuber, Pohlman, and our research librarian, Amy Ferguson. Together, we set out to map the global landscape of chiropractic clinical outcomes registries, examining their use in research, quality improvement, and policy development.
Understanding Clinical Outcomes Registries
A clinical outcomes registry is a structured system designed to track patient outcomes—such as symptoms, function, or quality of life—over time for specific conditions or interventions. Unlike clinical databases, which collect broad data for billing, administration, or general research, registries are precise, focusing on condition-specific outcomes to identify trends, enhance care quality, and support research or policy. They also differ from Practice-based Research Networks (PBRNs), where clinicians collaborate to study care delivery using diverse data sources. Registries, by contrast, are laser-focused on standardized, longitudinal data collection.
Why Registries Are Vital for Chiropractic
Registries offer chiropractors a cost-effective, flexible way to gather real-world evidence, surpassing the limitations of resource-intensive clinical trials. They enable long-term follow-up, critical for understanding chronic conditions often treated by chiropractors. With modern technologies like smartphones and cloud-based platforms, data collection is more accessible than ever. For a profession practiced in over 90 countries and increasingly integrated into global healthcare, registries provide a unique opportunity to document outcomes across diverse populations and settings, strengthening chiropractic’s evidence base.
Moreover, registries support evidence-based practice, enhance patient safety, and enable personalized care. They allow chiropractors to validate effective techniques, challenge outdated assumptions, and contribute to health policy. As chiropractic continues to grow within mainstream healthcare, registries could position the profession as a leader in data-driven care, fostering collaboration with other disciplines and improving patient outcomes worldwide.
A Step Toward the Future
Our scoping review is a foundational step toward understanding the state of chiropractic clinical outcomes registries. While the profession has yet to fully embrace this tool, the potential is immense. By investing in registries, chiropractic can build a stronger, evidence-based future, grounded in data that empowers clinicians, informs policy, and, most importantly, improves the lives of patients. We hope this work inspires action to close the registry gap and elevate chiropractic care on a global scale.
Joel Carmichael, DC, PhD practices at The Center for Spine, Sport & Physical Medicine in Colorado. He teaches at Universidad Central del Caribe in Puerto Rico and maintains volunteer clinical faculty status at the University of Colorado School of Medicine. His research seeks to improve the practice habits of sport and spine professionals. Dr. Carmichael loves teaching, latté art, C.S. Lewis, and an occasional morsel of chocolate. He and his wife enjoy morning strolls with their golden retrievers, Stella and Noli.
