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.