Rehab RAC 'n' Roll

By Craig Liebenson, DC

Mention a research meeting to practicing chiropractors and you will get a typical response: "Boring!" Mention Chicago in the summertime and you think "hot and muggy." So, it was surprising that the recent Research Agenda Conference V (RAC V) was anything but boring, and the weather in "Chi-town" was "brilliant-yet-breezy." (See "Research Agenda Conference (RAC V): The Research Funds Are Available, but Must Be Used Wisely," DC, Aug. 18, 2000 or at http://www.chiroweb.com/archives/18/18/12.html.)

Bill Meeker,DC, director of research at Palmer University, chaired an exciting look into the future of chiropractic. While private practitioners (including myself) made up less than 10 percent of the meeting's attendance of nearly 200, it seemed that we were the focus of the meeting.

Dr. Meeker has a way of making all the different constituents feel like this meeting was designed for them, from practitioners and college faculty members, to basic science and clinical researchers. How did he do this, and what are the implications for practicing DCs?
From the start it was clear that this was a special gathering. Opening remarks by Drs. Meeker, Jay Triano and Cheryl Hawk (the original main author of the contract proposal to the U.S. Health Resources Services Administration) suggested that the research agenda could not fulfill its mission without paying greater attention to practicing DCs. They admitted that something was "topsy-turvy" in chiropractic research when there were fewer and fewer case studies than randomized clinical trials.

Here are a few observations I can share with you about what was discussed:

emphasis on researchers becoming more sensitive to what questions clinicians want or need answered;
more interest in case studies;
encouraging more private practitioners to attend;
Saturday's talks by professors Gail Jensen and Benjamin Crabtree touched on one of the most important areas for future research: how to change clinician behavior, since it is clear that guidelines don't automatically become incorporated.

Some other presentations that were especially noteworthy:

The elegant Partap Khalsa,DC,PhD, a talk describing how cyclical repetitive loading significantly decreases muscular control of joint stability.
Dr. Hawk clearly showed how chiropractic researchers need more thoughtful case studies from practitioners, and that researchers need more guidance from practitioners on what to study.
A workshop by Al Adams,DC,PhD, was a brilliant example of active learning. Dr. Adams showed how to detect if a journal article's conclusions are trustworthy.
Robert Cooperstein,DC,MA, showed that an academician who continues to practice is best suited to cut through the tangled web of data and studies and ask some really useful clinical questions. One example is the probing question he raised about which of our diagnostic tests has proven clinical utility.
Bob Mootz,DC, managed a rare feat-richly informing his audience without ever making us feel like he was lecturing. His topic was the daunting "Overcoming the Disconnect between Research, Policy, Practice and Education."
Raymond Brodeur DC,PhD, did a wonderful job attempting to balance the interests of practitioners, technique advocates and scientific colleagues in what easily could have degenerated into philosophical mudslinging.
A few suggestions for RAC VI that are relevant from a rehabilitory standpoint: It would be nice to have Stuart McGill,PhD, at a RAC conference. He probably has the most active biomechanics lab in the musculoskeletal field and is a friend to chiropractic. He has a special interest in exercise, mechanism of spine injury and spinal manipulation. While RAC V wisely framed chiropractic within the twin cornerstones of biomechanics and neurophysiology, the psychosocial dimension was notable by its absence from the bulk of the presentations. No less an authority than Jennifer Bolton,PhD, of Anglo European Chiropractic College was in attendance; In the past, she has shed much-needed light on the current state of evidence in this field as it relates to chiropractic.

Lastly, my recommendation is that (as has been done by the American Academy of Orthopedic Surgeons and the International Forum for Primary Care Research on Low Back Pain) it would be nice to formalize a priority statement summarizing:

what major new knowledge has been gained recently;
the major research agendas for the future.

RAC VI is set for July 2001. Information about it and RAC V can be found at http://www.c3r.org and http://www.palmer.edu. I hope that the positive energy of our research leaders, such as Drs. Meeker and Hawk, will galvanize scientific efforts so that the practitioners' voices will not only be heard, but will resonate.

I never expected RAC to be so much fun. Palmer's facilitation of this event is something of which the whole profession can be proud. It is something invaluable to chiropractic.

Craig Liebenson,DC
Los Angeles, California

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