WCA issues position paper on research

The Board of Directors of the World Chiropractic Alliance (WCA) recently voted to approve an official position paper on research, which emphasizes the need for ongoing chiropractic research, including case studies.

"The need for scientific research cannot be overemphasized," said WCA President Terry A. Rondberg, DC. "The lack of solid, practice based research to validate chiropractic care is the last and most damning criticism made of our profession. All too often, chiropractic is criticized as an 'unscientific' discipline, lacking empirical research to validate the assertion that vertebral subluxations have an adverse affect on the human nervous system and, by extension, on general health and well being. To overcome this criticism, it is essential that the chiropractic profession conduct research that will allow for the objective comparison of health outcomes from the widest possible spectrum of the population."

Dr. Rondberg noted that whenever the WCA is called to defend chiropractic, it turns to research findings. In the past few months alone, the WCA has been called to defend the profession against attacks from media, governments and medical opponents, including claims that chiropractic is linked to strokes and laws that prohibit chiropractic for children. In each case, the WCA cited chiropractic research to back up its arguments.

"However, much of that research is dated and in need of updating and expansion," Rondberg stressed. "We cannot continue to rehash old research findings, no matter how impressive."

He also noted that far more research must be aimed at quality of life issues. In the past, many chiropractic research projects were disease oriented, giving evidence of chiropractic's effectiveness in addressing specific health conditions rather than general levels of wellness.

The goal of new research should be to provide objective evidence of technique and practitioner specific efficacy and a uniform chiropractic care evaluation and reporting system. It should also help to quantify the nature and degree of subluxation in patients and provide comparative analysis of technique and practitioner results.

The goal of the WCA position paper is to set forth the organization's policy on research and to stimulate profession wide discussion about the need for scientific research.

 The World Chiropractic Alliance Position Paper on Research Policy

 The World Chiropractic Alliance is committed to the highest standards of the professional practice of chiropractic and to the highest standards of ethical research conduct.

The World Chiropractic Alliance encourages research by chiropractic colleges, universities and research institutions, and practice‑based studies conducted by individual doctors of chiropractic, e.g., case reports and other health outcomes studies, as part of a continuing learning process that will ultimately result in better practitioners and patient care. 

Research conducted across these many fronts, including collaborative interdisciplinary studies with experts from a variety of other health fields, will contribute to the ever‑growing body of knowledge and to a better understanding of the benefits of chiropractic care. 

It is expected that each member of the World Chiropractic Alliance will support research and other scholarly activities and be guided by the principles of best practices and evidence‑based health care delivery.  In particular, the latter includes precisely defining a patient problem and what information is required to resolve the problem; conducting an efficient search of the literature; selecting the best of the relevant studies, and applying rules of evidence to determine their validity.  Since evidence‑based health delivery involves skills of problem definition, searching, evaluating, and applying original scientific literature, it is incumbent on members of the chiropractic profession to apply these skills to their practice.

Strict codes of conduct govern the use of humans in research and these guidelines in the United States are set forth by the Office for Human Subjects Research (OHSR) at the National Institutes of Health, by state law where applicable, and the Privacy Rule as part of the Health Information Portability and Accountability Act (HIPAA) of 1996, administered by the Department of Health and Human Services.  Under this act, Doctors of Chiropractic are considered "covered entities" and must comply with all HIPAA provisions.  For covered entities, compliance with these regulations, known as the Privacy rule, was required as of April 14, 2003. 

The Privacy Rule does not prohibit the publication of patient finding, but it does provide very specific guidelines for using patient material for research purposes. Health professionals must understand fully their obligations under the Privacy rule before disclosing patient data to others or before initiating research themselves.  

Moreover, the World Chiropractic Alliance cautions it members that it regards the practice of utilizing research programs for the specific purpose of patient solicitation to be an unacceptable and possibly illegal method of patient inducement that will ultimately damage the credibility of chiropractic as a whole and, in particular, damage the credibility of chiropractic research. 

However, when research does result in care rendered by a doctor of chiropractic, a disclaimer, patient privacy disclosure statement, and a proper informed consent document must be signed.  This is the research volunteer's acknowledgment that they fully understand the research project complies with all relevant federal and/or all international research guidelines and, as part of this document, they fully disclose any financial conflict of interests.

The World Chiropractic Alliance recognizes that a normal part of the everyday chiropractic practice involves communication in some form that will allow members of the public to better understand the benefits of chiropractic care and to recognize the services available from a specific doctor of chiropractic. 

Being able to present to colleagues, patients and the public in a succinct fashion the content of the scientific literature, and its strengths and weaknesses, and the ability to extract the clinical message and its application to patient care are considered evidence of successful "critical appraisal," best‑practice skills in evidence‑based health delivery.