DoD Grant – Visit to Ft. Campbell, KY

Last week I had the opportunity to drive a van from Davenport, IA to Ft. Campbell, KY. The van was loaded up with all the equipment that had been assembled to conduct one portion of the Department of Defense (DoD) grant that the Palmer Center for Chiropractic Research (PCCR) received in 2011. The objective of this project in the grant, as posed by the DoD, is to study the effects of chiropractic treatment on the reaction times of Special Operations Forces. The specific experiments to accurately and precisely measure reaction times were developed, tested and refined through a pilot study at the PCCR in Davenport, IA.

Once at Ft. Campbell, I met up with others involved in the study who came from around the country. This included project managers from other DoD grant military sites and various others working with us on the project. One of these folks was a gentleman who helped with the development of the experiments that we are using.  Once we got all of the equipment unloaded from the van we reassembled it and turned it on – hoping for the best. Good news! It all worked just as it should.

We spent some time testing the various experiments a few times so everybody there could see how they all worked and feel comfortable with the protocols. We also spent some time coordinating with the military personnel there in the hospital and in the physical therapy facility where our equipment is now located. They were all very supportive and accommodating. After all these months of getting to this point – it looks like everything is going to work out a-okay. I’ll keep you posted.

Submitted by Jim DeVocht, DC, MS, PhD

Over the last 5 years…

Last Thursday, faculty from the PCCR met to rate our progress on planned initiatives over the past year, and to set new goals for the next fiscal year. As part of this exercise, we reviewed the 5 year vision statement, finalized in January, 2008. Below is an excerpt from that 2008 document.

Today, thanks to creative vision and productive teamwork at the Palmer Center for Chiropractic Research (PCCR), the PCCR is acknowledged by both scientific peers and federal funding agencies as the premier center for chiropractic research in the world. Five years ago, PCCR investigators began advancing from a strong platform that had already been built in basic science research toward an overarching goal: establishing the first translational research center for chiropractic. Translational research is focused on making science more directly relevant to improving human health. Currently, the PCCR is conducting groundbreaking research that will shape daily chiropractic practice worldwide. This remarkable achievement has been accomplished, in large part, by integrating Palmer’s basic research program with an expanded clinical research capacity. The PCCR has further developed its clinical and translational research abilities, strengthened scientific expertise and research infrastructure across all campuses, continued to build partnerships with other scientific collaborators, and diversified funding sources.

Since this was written, the PCCR has received a $3.6M award from  NIH specifically designed to build our collaborative translational research capabilities, a $5.1 RAND subcontract from the Department of Defense to mount the largest study of chiropractic to date, and a $1.3M grant from HRSA to study chiropractic collaborative teams in treatment Medicare patients. Our clinical research infrastructure staff has grown from 26 to 34, with the ability to conduct multiple clinical trials simultaneously. We built a molecular biology lab on our Florida campus and over the past 18 months more than half of the 27 the articles published by our faculty and staff were in journals with an impact factor above 2.0.

While we are proud of our accomplishments over the past five years, we are most excited about the platform that we’ve built, which will enable us to  launch an even more ambitious plan for the next five years.

Submitted by Christine Goertz, DC, PhD

Science: it can actually make a difference…

On May 9, 2013 Samueli Institute President and CEO Wayne B. Jonas, MD, testified before the U.S. Senate Committee on Veterans’ Affairs. In his testimony, he stated strong support for further integration and expansion of evidence-based chiropractic services with the VA system. Dr. Jonas made reference to a study recently published in Spine by PCCR investigators. This study showed a statistically and clinically significant reduction in acute low back pain and improved physical functioning among active-duty military personnel following chiropractic care plus medical care when compared to medical care alone. His testimony gives witness to the critical role that research evidence plays in supporting policy recommendations.

Read more below about recently introduced Congressional bills to support the expansion of chiropractic services within the VA system and listen to Dr. Jonas’ full testimony.

S. 422: Chiropractic Care Available to All Veterans Act of 2013

H.R. 921 Chiropractic Care Available to All Veterans Act of 2013

S. 852 Veterans’ Health Promotion Act of 2013

Listen to Wayne Jonas’ Full Testimony (6 minutes: Beginning at 1:09:00)

 

Submitted by Christine Goertz, DC, PhD 

Dr. Goertz is the Vice-Chancellor for Research and Health Policy at Palmer College of Chiropractic since 2006 and a member of the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors. She received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University and her Ph.D. in Health Services Research, Policy and Administration from the University of Minnesota. Dr. Goertz has more than 20 years of experience as a scientist and in science administration, including three years as a Program Officer at the National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health (NIH), where she managed a $50 million portfolio.

Spine study: Improvement in back pain for military patients receiving chiropractic care; principal investigator Dr. Christine Goertz

Study published in Spine demonstrates significant improvement in low back pain for active-duty military patients receiving chiropractic care

Patients with acute low back pain receiving a combination of chiropractic manipulative therapy and standard medical care experienced a statistically and clinically significant reduction in their back pain and improved physical functioning when compared to those receiving standard medical care alone, reports an article in the April 15 issue of Spine.

The pragmatic, patient-centered, two-arm randomized controlled trial pilot study was funded by a grant from Samueli Institute, Alexandria Va., and conducted from February 2008 to June 2009 at William Beaumont Army Medical Center (WBAMC), Fort Bliss, El Paso, Texas. Participants were 91 active-duty military personnel between the ages of 18 and 35 years old.

“While a number of studies have shown spinal manipulation to be effective in treating low back pain in research settings, the appropriate role of chiropractic care in treating low back pain within the health care delivery system, including the military, has not been clearly established,” said study Principal Investigator Christine Goertz, D.C., Ph.D., vice chancellor for research and health policy for Palmer College of Chiropractic. “We know very little about the impact of chiropractic manipulative therapy on diverse populations in real-world settings. This study is the first step in filling that gap in our knowledge.”

“It is critical that we explore drug-less approaches to reduce pain,” said Wayne B. Jonas, M.D., President and CEO of Samueli Institute. “Chiropractic manipulation is an important option to consider for musculoskeletal disorders, which is the most prevalent pain complaint in the military.”

Study highlights included:

  • Adjusted mean Roland-Morris Disability Questionnaire scores were significantly better in the standard medical care plus chiropractic manipulative therapy group than in the standard medical care group at both week two (8.9 vs. 12.9; p = <0.001) and week four (8.0 vs. 12.0; p = 0.004),
  • Mean Numerical Pain Rating Scale (0-10) scores were significantly improved in the group that received chiropractic manipulative therapy when compared to standard medical care alone at both week two (3.9 vs. 6.1; p = <0.001) and week four (3.9 vs. 5.2; p = < 0.02),
  • Seventy-three percent of participants in the standard medical care plus chiropractic manipulative therapy group rated their global improvement as pain completely gone, much better or moderately better, compared to 17 percent in the standard medical care group.

Col. Richard Petri is the Chief of the Interdisciplinary Pain Management Center (IPMC) at WBAMC.  “This is a significant step for recognizing the value of chiropractic care in the military,” he said. “Continued research in this area will ultimately result in better healthcare delivery systems as well as the improved health of our beneficiaries.”

“While these findings are exciting, they need to be confirmed with additional research that replicates this study on a larger scale,” Dr. Goertz added. “Palmer College, the RAND Corporation and Samueli Institute received a $7.4 million, four-year grant from the Department of Defense last year to conduct a similar multi-site clinical trial, this time with a sample size of 750 active-duty military personnel.”

Additional study authors are:

  • Cynthia R. Long, Ph.D., Palmer Center for Chiropractic Research
  • Maria A. Hondras, D.C., M.P.H., Palmer Center for Chiropractic Research
  • Richard Petri, M.D., Physical Medicine and Integrative Care Services, Ft. Bliss, Texas
  • Roxana Delgado, M.S., Samueli Institute
  • Dana J. Lawrence, D.C., M.Med.Ed., M.A., Palmer College of Chiropractic
  • Edward F. Owens, Jr., M.S., D.C., TriMax Direct, St. Paul, Minn.
  • William C. Meeker, D.C., M.P.H., Palmer College of Chiropractic, West Campus

The Palmer Center for Chiropractic Research, headquartered on the Palmer College of Chiropractic campus in Davenport, Iowa, is the largest institutional chiropractic research effort in the world, promoting excellence and leadership in scientific research. The PCCR has the largest budget for research in a chiropractic college, receiving grants from the National Institutes of Health, National Center for Complementary and Alternative Medicine, the U.S. Health Resources and Services Administration, and now the Congressionally Directed Medical Research Program. Since 2000, these grant awards have totaled more than $35 million.

Palmer College of Chiropractic consists of three campuses—the main campus in Davenport, Iowa, and branch campuses in San Jose, Calif., and Port Orange, Fla. The College was founded in Davenport, Iowa, by the discoverer of chiropractic, D.D. Palmer, in 1897. Today Palmer College of Chiropractic has more than 2,100 students attending its three campuses and more than 26,000 alumni practicing worldwide.

Samueli Institute is a non-profit research organization supporting the scientific investigation of healing processes and their role in medicine and health care.

The project was funded by Samueli Institute, out of grant #MDA905-03-C-0003 received from Uniformed Services University of the Health Sciences. The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation.

PCCR researchers and collaborator publish article on spinal manipulation and neural responses

Relationship between Biomechanical Characteristics of Spinal Manipulation and Neural Responses in an Animal Model: Effect of Linear Control of Thrust Displacement versus Force, Thrust Amplitude, Thrust Duration, and Thrust Rate

William R. Reed, Dong-Yuan Cao, Cynthia R. Long, Gregory N. Kawchuk, and Joel G. Pickar

Received 15 September 2012; Revised 2 December 2012; Accepted 12 December 2012

Academic Editor: Vincenzo De Feo

Copyright © 2013 William R. Reed et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

High velocity low amplitude spinal manipulation (HVLA-SM) is used frequently to treat musculoskeletal complaints. Little is known about the intervention’s biomechanical characteristics that determine its clinical benefit. Using an animal preparation, we determined how neural activity from lumbar muscle spindles during a lumbar HVLA-SM is affected by the type of thrust control and by the thrust’s amplitude, duration, and rate. A mechanical device was used to apply a linear increase in thrust displacement or force and to control thrust duration. Under displacement control, neural responses during the HVLA-SM increased in a fashion graded with thrust amplitude. Under force control neural responses were similar regardless of the thrust amplitude. Decreasing thrust durations at all thrust amplitudes except the smallest thrust displacement had an overall significant effect on increasing muscle spindle activity during the HVLA-SMs. Under force control, spindle responses specifically and significantly increased between thrust durations of 75 and 150 ms suggesting the presence of a threshold value. Thrust velocities greater than 20–30 mm/s and thrust rates greater than 300 N/s tended to maximize the spindle responses. This study provides a basis for considering biomechanical characteristics of an HVLA-SM that should be measured and reported in clinical efficacy studies to help define effective clinical dosages.

Full-text article: http://www.hindawi.com/journals/ecam/2013/492039/

Collaborative care RCT protocol published

Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA): study protocol for a randomized controlled trial

Christine M Goertz, Stacie A Salsbury, Robert D Vining, Cynthia R Long, Andrew A Andresen, Mark E Jones, Kevin J Lyons, Maria A Hondras, Lisa Z Killinger, Fredric D Wolinsky and Robert B Wallace

Trials 2013, 14:18 doi:10.1186/1745-6215-14-18

Published: 16 January 2013

Abstract

Background

Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults.

Methods/design

This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits of progress notes and content analysis of clinical trial notes.

Discussion

This pragmatic, pilot randomized controlled trial uses a mixed method approach to evaluate the clinical effectiveness, feasibility, and participant and provider perceptions of collaborative care between medical doctors and doctors of chiropractic in the treatment of older adults with low back pain.

Trial registration

This trial registered in ClinicalTrials.gov on 04 March 2011 with the ID number of NCT01312233.

Keywords: Aged; Chiropractic; Education; Professional; Electronic health records; Family practice; Integrative medicine; Interprofessional relations; Low back pain; Therapy

Full-text article: http://www.trialsjournal.com/content/14/1/18

What’s new at the PCCR?

The following piece was submitted to Palmer College of Chiropractic’s student newspaper, The Beacon. We thought our blog readers may enjoy reading it as well.

What’s new at the PCCR?

Written by: Drs. Christine Goertz and Nicole Homb 

Do you ever look up at the big white and glass building next to the TV station and wonder what exactly happens in there? You know, the one that says Palmer Center for Chiropractic Research (PCCR) in big letters on the sign out front?  The purpose of this new, regular column in the Beacon is to make sure you know the answer to that question the next time you walk by. The PCCR is the largest and most highly funded research effort in the chiropractic educational community. It encompasses all three Palmer campuses and employs more than 40 professionals including administrators, faculty members, professional and administrative staff and clinical research fellows. The annual budget tops $7 million per year, $5 million from grants and contracts.

We, at the PCCR, are committed to asking questions that are relevant to patient care, and finding answers based on rigorous scientific methods. The current era of health care reform is an exciting time to be a scientist, as we search for new approaches to health care delivery that increase quality and decrease costs. The PCCR is at the forefront of that effort in chiropractic.

This month, we want to highlight two of our ongoing clinical trials. Both are National Institutes of Health-funded studies. The Measuring Chiropractic Delivery for Neck Pain Clinical Trial (MCD) study seeks to recruit 45 participants between the ages of 18 and 70 with neck pain or neck-related arm pain. The purpose of the study is to examine the patient‐centered clinical and biomechanical outcomes of a Cox flexion distraction treatment for neck pain or disability. We also will evaluate the ability of the doctor of chiropractic to deliver the manual cervical distraction within specified force ranges. An exploratory aim of this study is to evaluate EMG measurement during treatment delivery. The muscles surrounding the neck could alter the forces transmitted to the cervical spine and could alter the treatment effectiveness.

Manual cervical distraction is hypothesized to create inter-segmental separation at a targeted segment under the application of traction via a load localizing hand contact and with the assistance of the specialized treatment table (Cox 2004, 1999). The resulting traction‐induced inter-segmental motion is thought to open the intervertebral foramen through which spinal nerves pass and also decrease intradiscal pressure. This decreased pressure is thought to allow retraction (Kroeber et al. 2002, 2005) of the prolapsed disc, contributing to improved solute and nutrient transport, and altering the chemical environment of nociceptors in the outer annular layers of the disc. Manually‐localized lumbar distraction has already been shown to decrease intervertebral discal pressure in cadaveric lumbar discs (Cox 1999).

One challenging issue in the study of chiropractic is the development of sham and/or minimal intervention procedures suitable for use as control groups in clinical trials. Active treatment requires substantial physical contact between a study clinician and the study participant, either directly or through a mechanical intermediary. Consequently, it is difficult to introduce differences in manual therapy procedures that distinguish sham and/or minimal interventions from the active treatment, but are not immediately obvious to the study participant. In the MCD study, we will be assessing believability characteristics (i.e. the extent to which the participant believes the chiropractic care they received will be helpful). Another challenging issue is training clinicians to deliver standardized adjustments within specified force ranges.

In the second study, Patient Response to Spinal Manipulation (PRiSM), 80 participants between the ages of 21 and 65 with low back pain are being sought to participate in a trial of high velocity low amplitude (HVLA) spinal adjustments. In the PRiSM study, participants with chronic low back pain will meet with a study doctor 12 times over the course of six weeks. This is a biomechanical study that is designed to monitor both physiological and patient self-report outcome measures. In addition, as there is little quantitative information on spinal adjustment procedures reported in clinical trials, the study is designed to collect preliminary kinetic measures of the adjustments (e.g. force-time profiles).

Each of the study participants will receive two sets of adjustments to the low back per week, with the location based on the doctor’s clinical judgment, over a six week period. Physiological assessments will be performed immediately before and after adjustments during treatment visits 1, 5 and 12 (six sets of assessments in total). During these same treatment visits, we will capture the kinetic measures during the adjustments for spinal segment load analysis. We will further collect thrusting force-time profiles of spinal adjustments delivered for thrust contact force analysis. Participant patient-centered outcomes will be measured at baseline and at treatment visits 1, 6 and 13.

While we are not able to ask Palmer students, faculty and staff to join either of these studies as participants due to their intimate knowledge of chiropractic, if you know someone outside of our college community with low back or neck pain who might be interested in the study, please ask them to contact us at (563) 884-5188 or at research-clinic@palmer.edu. Also, if you have a question or topic that you would like to see discussed in a future research column, please contact Katie Hoyt at (563) 884-5198 or at katie.hoyt@palmer.edu.

The ghosts of research

During any given day I am working to submit a manuscript for work that is completed (10 currently in process), dealing with the day-to-day problem-solving and logistics involved in data collection for current projects (right now 6 clinical trials), and writing, at least in my head, the next grant application for NIH or HRSA or the DoD (2 large projects and one pilot study).

Today is a classic example. I had separate conversations with co-authors on three different manuscripts. One is presenting results from a pilot study designed to evaluate upper cervical manipulation in people that are pre-hypertensive or have stage I hypertension.  The next is presenting results from a large biomechanical outcomes study for people with chronic low back pain. The third article is related to the development of standards for evaluating patient reported outcome performance measures.

I, then, attended a steering committee meeting, which the PCCR holds weekly for all of our planned and ongoing clinical trials. This meeting was for a study investigating whether or not the delivery of a chiropractic adjustment in a certain way, as estimated by thrust contact force and spinal segment load, are related to patient-centered outcomes in patients with chronic low back pain. The main topic of conversation was how to make sure that we meet our recruitment goals. Finally, I talked with potential collaborators at a large, well-known university on the east coast about a potential joint project that will likely be submitted to NIH in late 2013. As a scientist, one learns to be comfortable sharing an office crowded with the ghost of research past, the ghost of research present, and ghost of research future…

Submitted by Christine Goertz, DC, PhD 

Dr. Goertz is the Vice-Chancellor for Research and Health Policy at Palmer College of Chiropractic since 2006 and a member of the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors. She received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University and her Ph.D. in Health Services Research, Policy and Administration from the University of Minnesota. Dr. Goertz has more than 20 years of experience as a scientist and in science administration, including three years as a Program Officer at the National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health (NIH), where she managed a $50 million portfolio.

Welcome to our blog!

Welcome to the new Palmer Center for Chiropractic Research blog, “On the Leading Edge of Chiropractic Science.” Our goal is to share information regarding our patient centered, translational research efforts in chiropractic. It is on this page that you will hear first about our clinical trials and basic science plans, work, and results. You will also get a firsthand look at the daily life shared by a team of scientists committed to the conduct of high quality, patient-centered, clinically relevant research. In summary, we want to show you what we do, why we do it, and how our work translates into better patient outcomes for those who receive chiropractic care.

We hope you enjoy this blog and look forward to hearing from you! Please let us know if you have questions, comments, or would like us to focus on a special area of interest.

Submitted by Christine Goertz, DC, PhD 

Dr. Goertz is the Vice-Chancellor for Research and Health Policy at Palmer College of Chiropractic since 2006 and a member of the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors. She received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University and her Ph.D. in Health Services Research, Policy and Administration from the University of Minnesota. Dr. Goertz has more than 20 years of experience as a scientist and in science administration, including three years as a Program Officer at the National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health (NIH), where she managed a $50 million portfolio.

Bains des Paquis, World Humanitarian Day and MORE seminars!

“Bain”…des Pâquis!

While recent media coverage and publicity of the presidential race may have you sensitized to associate the word “Bain” with “Bain Capital,” in French the word means “bath,” although it is pronounced differently. In Geneva, Bains des Pâquis is a popular Genevois destination that is frequented by the intern community year round. It features a long pier that jets out into the middle of Lake Geneva providing stunning views of the shoreline. While most interns visit just to relax and enjoy the view, there are opportunities to enjoy a Turkish bath which gives the area its name.

World Humanitarian Day

Each year on August 19, World Humanitarian Day is observed in recognition of humanitarian workers “who face danger and adversity in order to help others.” This year’s theme was “I was here” and echoes a message of doing something good, somewhere, for someone else. The day marks the 9th anniversary of a bombing at the United Nations headquarters in Baghdad that killed 22 UN staff, including WHO staff.

http://www.who.int/mediacentre/events/annual/world_humanitarian_day/en/index.html

Seminars attended in the past two weeks…

An Introduction to Health System Models with a focus on Macro and Micro systems
Presented by Dr. Moazzam Ali

http://www.linkedin.com/pub/moazzam-ali/25/206/297

Obstetric Fistula and WHO Contribution
Presented by Mariana Widmer

http://www.linkedin.com/pub/mariana-widmer/48/811/535

Programme Monitoring and Evaluation part II: how to deal with health system and facility-based information
Presented by Dr. Alfredo Fort

http://www.gfmer.ch/GFMER_members/Alfredo-Fort.htm

Submitted by Nicole M. Homb, D.C.

Nicole is a Clinical Research Fellow at the Palmer Center for Chiropractic Research. She is pursuing her master’s degree in Clinical Research and is interning at the World Health Organization from June – October, 2012.

The People

Faculty, staff, and administrators at the Palmer Center for Chiropractic Research are dedicated individuals who seek to advance public health by developing knowledge and translating that knowledge to the practice of chiropractic health care. Currently, the PCCR employs more than 40 professionals including administrators, faculty members, professional and administrative staff and clinical research fellows.

The Places

The PCCR has facilities on all three Palmer campuses (Davenport, Iowa; San Jose, Calif.; Port Orange, Fla.). The Davenport Campus includes pre-clinical and clinical biomechanics laboratories, neurophysiology laboratories and a dedicated research clinic. Palmer's Florida Campus includes a cellular and molecular biology laboratory while the West campus boasts a technique assessment facility.

The Projects

Over the last decade the PCCR has received over $30 million in federal funding through the National Institutes of Health (NIH), Health Resources and Services Administration (HRSA) and the Department of Defense (DoD). Current grant-funded research projects include six clinical trials and three basic science studies.