The Right Team

An effective research program starts with hiring highly qualified people with the vision and expertise to accurately assess genuine research needs and to pursue cutting-edge projects that do not duplicate the efforts of other colleges. In recent years, Cleveland Chiropractic College has assembled such a team, under the steady leadership of Cheryl Hawk, DC, PhD, Cleveland’s Vice President for Research and Scholarship. Dr. Hawk works closely with James Brantingham, DC, PhD., and Mark Pfefer, RN, MS, DC, who serve as Directors of Research at the Los Angeles and Kansas City campuses, respectively. Together, these research trendsetters have a track record of high-quality published research. They have forged a new path for the College, focusing on chiropractic approaches to lower extremity conditions, geriatrics and prevention.

Dr. Hawk is a highly respected chiropractic researcher. She explains the importance of a robust and sustained research program in terms most practicing chiropractors will understand: “With the emphasis on evidence-based practice and documenting outcomes, if you don’t have research, it’s going to be harder and harder to be included by third party payers. That’s really the bottom line and why everyone is realizing that research is important.” Hawk, who also chairs the Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters [CCGPP], has direct experience in using research to safeguard chiropractors’ practice rights, as part of CCGPP’s rapid response team, which fields an ongoing flow of requests from doctors facing refusals of coverage for some procedures by insurance companies. The rapid response team provides research evidence to substantiate procedures which are questioned.

Focus on Lower Extremity, Geriatrics and Prevention Research

Recognizing the need for Cleveland College to carve out a unique research niche rather than following in the footsteps of other colleges (some of which have specialized, for example, in low back pain or headache research), Drs. Hawk, Brantingham and Pfefer noted the lack of chiropractic research on older people, the fastest growing segment of the U.S. population. Among the most important priorities in geriatric healthcare is maintaining the ability to live independently. This requires being to walk and perform other bodily movements in a healthy fashion and, most importantly, to prevent falls that can result in disabling fractures. Such fractures are a key factor in patients’ needing to enter assisted living facilities or nursing homes.

Cleveland’s research leadership team saw three potentially important research themes emerging. First, because disorders of the ankle, knee and hip exert a major influence on ambulation and may also be a critical factor in avoiding falls, investigating chiropractic’s effects on lower extremity conditions should be a central focus of the College’s research agenda. Second, while virtually all chiropractic research to date has focused on evaluating treatments, possible preventive effects of chiropractic adjustments should also be included among the areas to be studied. Third, because too little research in both chiropractic and medicine has looked closely at the specific needs of elderly patients, geriatrics was identified as a key area of emphasis for Cleveland researchers.

To jump-start the enhanced focus on geriatrics, starting on July 6, 2009, all Cleveland Chiropractic College – Kansas City Health Center patients age 65 or older will be enrolled in research studies. This will significantly enlarge the number of subjects available to participate in future chiropractic research projects.

Selected Recent and Current Research Projects

Journal of Manipulative and Physiological Therapeutics, chiropractic’s flagship scholarly research journal, has accepted for publication a CCCLA study on chiropractic management of patellofemoral pain syndrome (pain around or behind the kneecap made worse by activities). According to Dr. Brantingham, Director of Research at CCCLA, “this project was incredibly useful for developing the ability of the clinic and the research department to work together.” As is so often the case, success breeds further success. With a track record on lower extremity research, Brantingham and colleagues were able to secure a grant from the UniHealth Foundation in Los Angeles to study chiropractic management of hip osteoarthritis. This is a fully powered clinical trial (with enough patients for results to potentially reach statistical significance) that is currently underway at CCCLA. In addition, another proposal for a trial on knee osteoarthritis is currently under consideration for a grant from another Los Angeles area foundation.

Other recent research that has been published (either by CCCLA faculty alone or jointly with Durban University of Technology in Durban, South Africa or the University of Surrey in Guildford, England) includes another trial on knee osteoarthritis, a prospective case series on meniscus injuries as well as the first studies of chiropractic adjusting for shoulder impingement, adhesive capsulitis and rotator cuff tendinopathy

At CCCKC, three studies have recently been completed. In one, patients over 65 in the Brookside and Overland Park clinics were observed over time, assessing the effects of chiropractic care on balance and function. Another, done in Raytown, Missouri, evaluated chiropractic care for residents of  independent living and assisted living facilities. The third project is a neck pain and dizziness study.

Research at the two campuses of Cleveland Chiropractic College is opening new doors for the profession and the College. Recent projects, particularly the lower extremity studies in Los Angeles and geriatrics studies in Kansas City, are the first steps in what promises to be a multi-year, in-depth exploration of topics of great importance to the chiropractic profession and the patients it serves.

Cleveland Chiropractic College Research

CURRENT EXTRAMURAL FUNDING

Foundation for Chiropractic Education and Research, Kansas City Campus: (Principal Investigator: Hawk)
Pilot Study: Does Chiropractic Care Decrease Fall Risk in Older Adults? $112,000 (2007-2009)

UniHealth Foundation, Los Angeles Campus: (PI: Brantingham)
Pilot Study: A randomized clinical trial comparing two manipulative protocols to assess changes in pain, ROM, quality of life, cost, and risk for falls in subjects with hip osteoarthritis. $100,000 (2008-2010

FCER, Kansas City Campus (PI: Hawk)
Consensus Process to Develop “Best Practices” Document for Chiropractic Care for Children $96,695 (2008-2009)

PUBLICATIONS 2008-2009
(Names of Cleveland Chiropractic College faculty in bold type)

Atkinson M, Matthews R, Brantingham JW, Globe G, Cassa T, Bonnefin D, Korporaal C. A randomized controlled trial to assess the efficacy of shoulder manipulation vs. placebo in the treatment of shoulder pain due to rotator cuff tendinopathy.J Amer Chiropr Assoc. Dec 2008 45(9):11-26.

Brantingham JW, Globe G, Tong V, Bates CC, Jukes J, Van-Houten C, Doorly K. Diversified chiropractic adjusting and management in the treatment of 5 clinically diagnosed meniscus injury patients with MRI imaging in 4 cases. J Amer Chiropr Assoc 2008 July;45(5):11-24.

Dippenaar D, Korporaal C, Jones A, Brantingham J, Globe G, Snyder W. Myofascial trigger points in the quadriceps femoris muscle of patellofemoral pain syndrome subjects assessed and correlated with NRS-101, algometry, and piloted patellofemoral pain severity and myofascial diagnostic scales. J Amer Chiropr Assoc 2008;45(2):16-28.

Evans MW, Ramcharan M, Ndetan H, Floyd R, Globe G, Pfefer M, Brantingham J, Jukes G. Hand hygiene and treatment table sanitizing in chiropractic teaching institutions: results of an education intervention to increase compliance Journal of Manipulative and Physiological Therapeutics (in press, 2009).

Evans, M, Campbell, A, Husbands, C, Breshears, J, Ndetan, H, Rupert, R. Cloth covered chiropractic treatment tables as a source of allergens and pathogenic microbes. J Chiropr Med 2008;7: 34-38.

Evans, M, Ndetan, H, Williams, R. Intentions of chiropractic interns regarding use of health promotion in practice: applying the Theory of Reasoned Action to identify attitudes, beliefs, and influencing factors. J Chiropr Educ 2009;23(1):17-27.

Evans, M, Ramcharan, M, Floyd, R, Globe, G, Ndetan, H, Williams, R, Ivie, R. A proposed protocol for hand and table sanitizing in chiropractic clinics and education institutions. J Chiropr Med 2009;8:37-47.

Evans, M, Williams, RD, Perko, M. Public health advocacy and chiropractic: a guide to helping your community reach its health objectives. J Chiropr Med 2008;7: 71-77.

Fish D, Kretzmann H, Brantingham JW, Globe G, Korporaal C, Moen J. A randomized clinical trial to determine the effect of combining a topical capsaicin cream and knee joint mobilization in the treatment of osteoarthritis of the knee J Amer Chiropr Assoc. Aug 2008;45(6):8-23.

Globe G, Redwood D, Brantingham JW, Hawk C, Terre L, Globe D, Mayer S. Improving preventive health services training in chiropractic colleges part II: Enhancing outcomes through improved training and accountability processes. J Manipulative Physiol Ther (in press).

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther 2008;31(9):651-658.

Hawk C, Cambron J, Pfefer M. Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain and dizziness in older adults. J Manipulative Physiol Ther (in press).

Hawk C, Cambron J. Chiropractic care for older adults: assessment of balance, dizziness and chronic pain. J Manipulative Physiol Ther (in press).

Hawk C, Cambron J, Pahmeyer D. Issues in conducting research in chiropractic college clinics. J Manipulative Physiol Ther 2008;31(4):301-307.

Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, Hawk C, Injeyan HS, Killinger L, Kopansky-Giles D, Lisi AJ, Mior SA, Smith M. Chiropractic and public health: current state and future vision. J Manipulative Physiol Ther 2008;31(6):397-410.

Khorsan R, Hawk C, Lisi AJ, Kizhatkkeveettil A. Spinal manipulative therapy for pregnancy and related conditions: a systematic review. Obstetr & Gynecol Survey 2009;64(6):416-427.

Khorsan R, Coulter I, Hawk C, Choate CG. Measures in chiropractic research: choosing patient based outcome assessment. J Manipulative Physiol Ther 2008;31(5):355-75.

Khorsan R, Smith M, Hawk C, Haas M. A public health immunization resource website for chiropractors. J Manipulative Physiol Ther (in press).

Lawrence DJ, Meeker W, Branson R, Bronfort G, Cates JR, Haas M, Haneline M, Micozzi M, Updyke W, Mootz R, Triano JJ, Hawk C. Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis. J Manipulative Physiol Ther 2008;31(9):659-674.

Marchiori DM, Henkin AB, Hawk C. Social communication skills of chiropractors: implications for professional practice. J Manipulative Physiol Ther 2008;31(9):682-9.

Ndetan HT, Sejong, B, Evans, M, Rupert, R, Singh KP. Characterization of health status and modifiable risk behavior—United States adults using chiropractic care as compared to general medical care. J Manipulative Physiol Ther (in press).

Pfefer MT. Peripheral neuropathy and neuropathic pain. In: Meyers J, Nieman D, editors. ACSM’s resources for clinical exercise physiology: musculoskeletal, neuromuscular, neoplastic, immunologic, and hematologic conditions. 2nd ed. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins; 2009.p. 104-112.

Rainbow DM, Weston JP, Brantingham JW, Globe G, Lee F. A prospective, clinical trial comparing chiropractic manipulation and exercise therapy vs. chiropractic mobilization and exercise therapy for treatment of patients suffering from adhesive capsulitis/frozen shoulder. J Amer Chiropr Assoc 2008;45(7):12-28.

Ramcharan, M, Evans, M, Burnham, K. Could microorganisms be lurking on your chiropractic table? J Amer Chiropr Assoc 2008;45(8):9-13.

Redwood D. The health reform moment: peril and possibility in the Obama era. J Altern Complement Med 2009;15(1):1-3

Redwood D, Globe G. Prevention and health promotion by chiropractors Am J Lifestyle Med 2008;2:537-545.

Redwood D, Hawk C, Cambron J, Vinjamury SJ, Bedard J. Do chiropractors identify with complementary and alternative medicine? Results of a survey. J Altern Complement Med 2008;14(4):361-8.

Redwood D. Chiropractic management of chronic low-back pain: Commentary on Wilkey et al. J Altern Complement Med 2008;14(5): 451-452.

Strunk RG, Hondras MA. A feasibility study assessing manual therapies to different regions of the spine for patients with subacute or chronic neck pain. J Chiropr Med 2008;7:1-8.

Daniel Redwood, DC, is an Associate Professor at Cleveland Chiropractic College – Kansas City and Editor-in-Chief of Health Insights Today (www.healthinsightstoday.com) and The Daily HIT (www.dailyhitblog.com).