Interview With Michael Schneider, DC, PhD,
On A Non-surgical Approach to Spinal Stenosis
SOURCE: Topics in Integrative Health Care 2015 (Sep 29); 6 (2)
Daniel Redwood, DC
Michael Schneider, DC, PhD, is an Associate Professor at the School of Health and Rehabilitation Sciences at the University of Pittsburgh.
Schneider was the only chiropractor to receive a grant as part of the Patient Centered Outcomes Research Institute’s (PCORI) first wave of 25 grants, in late 2012. PCORI was created as an independent entity by the Patient Protection and Affordable Care Act, with a mission to fund high-quality comparative effectiveness research. The topic of Dr. Schneider’s research is A Comparison of Nonsurgical Treatment Methods for Patients with Lumbar Spinal Stenosis.
Dr. Schneider serves on the postgraduate faculty of several chiropractic colleges, is program chair Chiropractic Health Care Section of American Public Health Association, and is a past chair of the Soft Tissue Committee of the Council on Chiropractic Guidelines and Practice Parameters. He has had numerous articles published in peer-reviewed research journals.
A graduate of the State University of New York at Binghamton who later received his PhD in Rehabilitation Science at the University of Pittsburgh, Schneider is among a growing cadre of chiropractic researchers who form a crucial bridge between chiropractic and other health professions.
You recently received a grant from the Patient Centered Outcomes Research Institute (PCORI) to study the comparative effectiveness of several different treatment options for spinal stenosis. What criteria did you have to meet to have your proposal selected? I understand that the competition was quite rigorous.
The grant mechanism is different than for a typical NIH [National Institutes of Health] grant. Probably the biggest difference, which worked to my advantage, was that as its name indicates, the Patient Centered Outcomes Research Institute is supposed to be about patient-centered outcomes. This means that they’re interested in very pragmatic types of studies, not necessarily studies on mechanisms of action.
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Also, PCORI is very big on effectiveness studies rather than efficacy studies. An example of an efficacy study would be one that compares two pills, where one is an active treatment and the other is a placebo. In efficacy studies, the research design is fastidiously controlled to analyze the effect of just one active treatment in isolation. A challenge with research on chiropractic is that most chiropractors don’t just do one active treatment in the real-life clinical setting. They may perform spinal manipulation but also recommend exercises or use other methods. So efficacy studies are not considered the ideal design for the “packages” of treatments typically used by chiropractors in private practice.
And so an effectiveness study, a pragmatic study, more accurately reflects the sort of care that someone would receive at a chiropractor’s office, or at some other practitioner’s office.