Research Priorities of the Canadian Chiropractic Profession: A Consensus Study Using a Modified Delphi Technique

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SOURCE:   Chiropractic & Manual Therapies 2017 (Dec 12); 25: 38

Simon D. French, Peter J. H. Beliveau, Paul Bruno, Steven R. Passmore, Jill A. Hayden, John Srbely and Greg N. Kawchuk

School of Rehabilitation Therapy,
Queen’s University

Background   Research funds are limited and a healthcare profession that supports research activity should establish research priority areas. The study objective was to identify research priority areas for the Canadian chiropractic profession, and for stakeholders in the chiropractic profession to rank these in order of importance.

Methods   We conducted a modified Delphi consensus study between August 2015 and May 2017 to determine the views of Canadian chiropractic organisations (e.g. Canadian Chiropractic Association; provincial associations) and stakeholder groups (e.g. chiropractic educational institutions; researchers). Participants completed three online Delphi survey rounds. In Round 1, participants suggested research areas within four broad research themes:

1)   Basic science;
2)   Clinical;
3)   Health services; and
4)   Population health.

In Round 2, researchers created sub-themes by categorising the areas suggested in Round 1, and participants judged the importance of the research sub-themes. We defined consensus as at least 70% of participants agreeing that a research area was “essential” or “very important”. In Round 3, results from Round 2 were presented to the participants to re-evaluate the importance of sub-themes. Finally, participants completed an online pairwise ranking activity to determine the rank order of the list of important research sub-themes.

Results   Fifty-seven participants, of 85 people invited, completed Round 1 (response rate 67%). Fifty-six participants completed Round 2, 55 completed Round 3, and 53 completed the ranking activity. After three Delphi rounds and the pairwise ranking activity was completed, the ranked list of research sub-themes considered important were:

1)   Integration of chiropractic care into multidisciplinary settings;
2)   Costs and cost-effectiveness of chiropractic care;
3)   Effect of chiropractic care on reducing medical services;
4)   Effects of chiropractic care;
5)   Safety/side effects of chiropractic care;
6)   Chiropractic care for older adults;
7)   Neurophysiological mechanisms and
       effects of spinal manipulative therapy;
8)   General mechanisms and effects of spinal manipulative therapy.

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Conclusions   This project identified research priority areas for the Canadian chiropractic profession. The top three priority areas were all in the area of health services research: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services.

Keywords   Chiropractic profession, Canada, Delphi study, Research priorities

From the FULL TEXT Article:


Supporting research is an essential activity for contemporary healthcare professions. The Canadian chiropractic profession has demonstrated a commitment to support research through several initiatives, such as the provision of financial and other support to researchers with an interest in chiropractic. [1] As only limited funds are available to undertake research, existing funds may be better utilised if directed to areas of priority.

Research priorities can be established to address identified gaps in knowledge and to maximise opportunities to develop a relevant evidence base for a healthcare profession. Priorities may be identified at different strategic levels. These may be at the level of a research centre [2], at a national strategic level, such as a healthcare profession’s priorities [3, 4], or at an international level for specific clinical areas, for example low back pain [5], pediatric rheumatology [6] or musculoskeletal conditions in general. [7]

In the United States and Europe, the chiropractic profession has developed research agendas that have been implemented with varying levels of success. [8-15] Previous efforts by the Canadian chiropractic profession to develop a research agenda occurred between the years 2000 and 2010. [1] Initial research efforts were aligned with national Canadian health research priorities, and focused on three research streams:

1)   Spinal biomechanics;
2)   Neurophysiology; and
3)   Epidemiology.

Funding raised by the profession for research was directed toward supporting research-intensive appointments in Canadian universities for individuals with appropriate research training and a chiropractic background. [1, 16] More recently, the focus of the profession has shifted to the support of projects rather than people, so there is an immediate need for the Canadian chiropractic profession to develop a national research agenda.

The aim of this project was to identify research priority areas for the Canadian chiropractic profession, and to rank these in order of importance, based on the views of stakeholders in the chiropractic profession. The results of this study will be used by the Canadian Chiropractic Research Foundation (CCRF), the largest research funding body of research activity within the Canadian chiropractic profession, to inform funding decisions for future research.

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