The minimum energy hypothesis: a unified model of fixation resolution

Doing the Same Thing and Expecting a Different Outcome: It Is Time for a Questioning Philosophy and Theory-Driven Chiropractic Research

OBJECTIVE

The purpose of this commentary is to discuss the philosophical and hypothetical underpinnings of chiropractic and consider whether there is a need for chiropractic to have a questioning philosophy and theory-driven process to guide future scientific endeavors in the profession.

DISCUSSION

The earliest beliefs of the chiropractic founders centered on chiropractic vertebral subluxation but differed on whether this was a static, bone-out-of-place misalignment or a lesion whereby joints had lost their normal direction or range of motion. More recently, new hypotheses such as dyskinesia, inflammation, and neuroplasticity attempt to explain the purported clinical effects of chiropractic. Yet practitioners and students advocate for both traditional viewpoints that typically tout misalignment and embrace a science of chiropractic. I propose that chiropractors should not have to choose between philosophy and science. Instead, they should advocate for adoption of a modern questioning philosophy that not only informs their clinical questions and drives their theories, but also that is in turn influenced by outcomes from their research. Such a questioning philosophy is in stark contrast with the dogma that some have mislabeled as "philosophy" in the profession. I recommend that a review of chiropractic hypotheses and a theory-driven research process is needed to help guide the profession's research agenda given its wide range of clinical activities and limited resources. As the chiropractic profession increasingly embraces evidence-informed practice, enhanced integration within the wider health care community may then result in further gains in utilization.

CONCLUSION

Theory-driven research that results from and subsequently informs a questioning philosophy may expose truths related to practice behaviors, activities, and outcomes, and spur more complete integration of chiropractic within the wider health care community.

Basic Science Research Related to Chiropractic Spinal Adjusting: The State of the Art and Recommendations Revisited

OBJECTIVE

The objectives of this white paper are to review and summarize the basic science literature relevant to spinal fixation (subluxation) and spinal adjusting procedures and to make specific recommendations for future research.

METHODS

PubMed, CINAHL, ICL, OSTMED, and MANTIS databases were searched by a multidisciplinary team for reports of basic science research (since 1995) related to spinal fixation (subluxation) and spinal adjusting (spinal manipulation). In addition, hand searches of the reference sections of studies judged to be important by the authors were also obtained. Each author used key words they determined to be most important to their field in designing their individual search strategy. Both animal and human studies were included in the literature searches, summaries, and recommendations for future research produced in this project.

DISCUSSION

The following topic areas were identified: anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system. A relevant summary of each topic area and specific recommendations for future research in each area were the primary objectives of this project.

CONCLUSIONS

The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper. Much more basic science research in these fields needs to be accomplished, and the recommendations at the end of each topic section should help researchers, funding agencies, and other decision makers develop specific research priorities.

PulStar differential compliance spinal instrument: a randomized interexaminer and intraexaminer reliability study

OBJECTIVE

To provide an entry-level, new technology reliability assessment of the PulStar computer-assisted, differential compliance spinal instrument.

SUBJECTS

Eighteen college students (9 male and 9 female) were recruited by announcements and personal contacts.

METHODS

Following approval of the consent process by the Institutional Review Board of Mississippi State University, a PulStar Function Recording and Analysis System (PulStarFRAS) device was evaluated for clinical reliability. Two examiners, blinded from data collection, used the instrument on individual subjects in random order (lying prone with their backs exposed) to administer light impulses (approximately equal to .9 J which produced a 3- to 4-lb force) at each segmental level throughout the cervical, dorsal, and lumbar spine using probe tips spaced 3 cm apart, straddling the spinous processes, while a computer recorded the findings (resistance on a scale of 0 to 25.5 lb force). Data were analyzed by Exploratory Data Analysis (EDA) with analysis of variance (ANOVA) testing and by use of the intraclass correlation coefficient (ICC). In addition, a mean test (ANOVA) was conducted to determine if a trend in variation occurred as a result of repeated light thrusts to the spine, independent of variance explained by different examiners.

RESULTS

Using EDA analysis and ANOVA, intraexaminer reliability for the 2 practitioners was very high but not perfect. This was confirmed by ICC statistics demonstrating good to excellent reliability for both practitioners (0.89 for the experienced practitioner, 0.78 for the newly trained practitioner). Interexaminer reliability of PulStar was similarly very high but not perfect based on EDA/ANOVA analysis and good to excellent (ICC = 0.87).

CONCLUSION

The PulStar mechanical adjusting device set to analysis mode appears to have good to excellent reliability when used by either an experienced or a novice (but trained) examiner. In addition, as a measure for resistance to a light thrust or spinal compliance, reliability was similarly good to excellent between the 2 doctors using the PulStar instrument.