The Research Challenge: An Update on the Progress of the CCCR

By William Meeker, DC, MPH, FICC

As the Consortial Center for Chiropractic Research (CCCR) closes in on its last year of support from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), it is good to consider the impact that federal funding has had on the overall chiropractic research effort. Originally, there were 12 specific aims that the CCCR was required to address, most of them falling into the areas of research capacity building, training and assisting chiropractic investigators, and reviewing, prioritizing and funding small pilot studies.

One of the overarching expectations was that the CCCR develop effective scientific collaborations between chiropractic scientists and experienced researchers in established research centers. This not only meant that we had to facilitate relationships between individuals, but that our institutions had to develop the administrative expertise to produce formal project subcontracts and related business agreements. For anyone who has attempted to handle a grant, there is much to do that has little to do with the specifics of the scientific project itself. The CCCR has been able to demonstrate the profession's ability in this regard.

To date, the CCCR has lived up to its consortial goal by involving seven chiropractic and six nonchiropractic institutions on its various functions. An additional seven chiropractic colleges (75 percent of North American chiropractic colleges in all) have participated in the CCCR (at least) by submitting pilot project applications and obtaining expert feedback. The most potent form of training is when investigators have their applications reviewed and critiqued by a set of experts. In fact, the CCCR has provided expert review for 64 applications, and has been able to financially support the best 19 to date.

In all cases of funded projects, including nonchiropractic institutions, chiropractic scientists are intimately involved. For example: Partap Khalsa, a chiropractor with a PhD in bioengineering, has developed his own bioengineering laboratory at the State University of New York at Stony Brook, where he has a faculty appointment. With funds from the CCCR, he has been able to pursue exciting work on the biomechanics of spinal facet joints.

As far as additional assistance and training goes, the Research Agenda Conference (RAC) is partially supported by funds from the CCCR, and this has become, in seven years, one of the most effective and productive scientific/education meetings in chiropractic. Other health professions are now trying to emulate the formula. The Research Agenda Conference is primarily funded by a contract from the U.S. Health Resources and Services Administration. Next year, as in the most previous event, the RAC will be held in conjunction with the annual conference of the Association of Chiropractic Colleges in March. (Stay tuned to this publication for details.)

In the past year, the following new projects have been initiated and are in progress. Space is limited to the title of the project, the names of two key investigators and the primary institution; but be aware that each project involves a great many more individuals important to its success. In some cases, the projects also involve more than one institution. Here are some featured topics and their presenters:

Cost-Effectiveness of Chiropractic Care: Gert Bronfort,DC,PhD, Roni Evans, DC,MS, Northwestern Health Sciences University.
SMT and Motor Systems Physiology: Donald Dishman,DC,MSc, Jeanmarie Burke,PhD; New York College of Chiropractic.
Chiropractic for Chronic Otitis Media with Effusion: David Eisenberg, MD, James Barassi,DC,MPH; Harvard University School of Medicine
Conservative Management of Neck Disorders: A Series of Cochrane Reviews: Anita Gross,MSc,PT, Gert Bronfort, DC,PhD; McMaster University
Dose-Response in Chiropractic Care for LBP: Mitchell Haas,DC, Dale Kraemer, PhD; Western States Chiropractic College.
Evaluation of a Chiropractic Manual Placebo: Cheryl Hawk,DC,PhD, Cynthia Long, PhD; Palmer Center for Chiropractic Research.
Facet Joint Capsule Strains During Spinal Manipulation: Partap Khalsa,DC, PhD, Yi-xian Qin,PhD; State University of New York.
Changes in Paraspinal Muscle Spindle Sensitivity: Joel Pickar,DC, PhD, Charles Henderson,DC,PhD; Palmer Center for Chiropractic Research
Trigger Point Metabolic and Microcirculatory Imbalances: Ronnie Sciotti, PhD, Robert Hickner,PhD, New York Chiropractic College.

This is an excellent mix of basic science and clinical science research that will lead to larger and more definitive studies in the future. It is fair to say that many of these studies and topics may not have been possible without the support and encouragement of the CCCR.

Success is also measured by noting the publications and presentations sponsored by the CCCR. So far, and with over half of the CCCR's projects still underway, this outstanding group of chiropractic scientists has published 26 peer-reviewed papers (some of which are still "in press"), and has made 51 citable presentations at various research and professional conferences. Many of these publications are reaching audiences that have little previous experience with chiropractic or chiropractic research.

Only time will tell the extent of the impact of the CCCR on chiropractic research overall. Success has also thrown into relief the challenges that still need to be met to continue the scientific momentum that has served the profession well in the past decade. These issues include:

an inadequate number of scientifically trained and experienced investigators and mentors;
an underdeveloped chiropractic theory and research agenda;
inadequate incentives for interdisciplinary scientific collaboration;
insufficient opportunities for training new chiropractic scientists and providing them with appropriate careers;
institutional ignorance of sponsored (grants) program administration and budgetary compliance and control;
inadequate basic science laboratories; and
research clinics with inadequate patient bases for clinical research

Even in these times of professional uncertainty, and declining enrollments in chiropractic institutions, it will behoove the profession to consider how important chiropractic research is for the future, and understand that short-term costs can yield large long-term benefits. We must continue to address these challenges, for there is so much still to do.

William Meeker,DC,MPH,FICC
Principal Investigator
Consortial Center for Chiropractic Research
Davenport, Iowa

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