C Martin Canadian Chiropractic Research Bulletin #8 · chiropractic care: Cochrane systematic...

J Can Chiropr Assoc 2003; 47(3) 217

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Canadian Chiropractic Research Bulletin #8

Dr. Chris Martin, DC

• Dr. Greg Kawchuk DC, PhD, who is Canada’s 1stuniversity-based Chiropractic Research Chair has beennominated for a Canada Research Chair Tier II at theUniversity of Alberta in Edmonton. This is a very sig-nificant milestone for the chiropractic profession. Inaddition, he has also become a member of the CIHRPeer Review Committee on Movement and [email protected]

• The CCA’s next university-based CIHR ChiropracticResearch Chair has been awarded to Dr. Mark ErwinDC, who is currently a PhD candidate at the Universityof Toronto and he will defend his work in November.He will take up the Chair in Phase II of the award. TheOntario Chiropractic Association has provided trueleadership and stewardship in funding this CIHR/CCRFpartnered award and the entire OCA Board of Directorsis to be commended. Building our intellectual researchcapacity and mobilizing interdisciplinary research willensure our future.

• On the October 4–5, 2002 we held our 3rd world classscientific Research Symposium with speakers such asDr. Mark Bisby, Vice-President-Research, CIHR andDr. Arne Ohlsson, Director, Cochrane Collaboration inaddition to our growing number of excellent chiro-practic researchers. Check out the JCCA March 2003issue at www.jcca-online.org to view “Evidenced basedchiropractic care: Cochrane systematic reviews ofhealth care interventions” and the “Report on the devel-opment of Canadian Clinical Practice Guidelines”.

• The CCA Research Agenda document has been furtherrefined by the members of the Consortium of CanadianChiropractic Research Centers at a CIHR/CCA fundedResearch Agenda Workshop. The Workshop, anotherhistoric first for our profession, was funded by fourCIHR Institutes:

The CCA Research CommitteeDr. Chris Martin (BC) – ChairDr. Rob Allaby (NB)Dr. Eric Jackson (ON)

The Canadian Chiropractic Association (CCA) ResearchCommittee activities continue to be focused on “HelpingCanadians live healthier lives”. Since our last update,many very positive activities and events have occurredabout which I am delighted to report.

218 J Can Chiropr Assoc 2003; 47(3)

Research Bulletin #8

Institute of Musculoskeletal Health and Arthritis (IMHA)Institute of Aging (IA)Institute of Neuroscience, Mental Health and Addiction(INMHA) andInstitute of Population and Public Health (IPPH)

Dr. Cy Frank, IMHA Scientific Director (University ofCalgary) and Dr. Elizabeth Badley, IMHA AdvisoryBoard (University of Toronto) were featured speakers andbrought tremendous insight to the Workshop.

The CCA Research Committee will be consulting with theCCA membership to provide a comprehensive opportunityfor all of our members to participate in setting the Associa-tion’s final research agenda for the next ten year period.

• Dr. Allan Gotlib, JCCA Editor and CCA Director, Re-search Programs, has recently been elected to the Ex-ecutive Committee of the Canadian Cochrane Networkand Center (CCN/C).www.cochrane.org

• Two new members have been added to our ResearchConsortium, Dr. Jeff Quon DC, MHSc at the Universityof British Columbia and Dr. Norman Teasdale PhD atUniversité Laval.

• The CCA Young Investigators Award was presented toDr. Danielle Stewart-Smith at our Research Sympo-sium in Toronto. Her work on mechanical disc proper-ties during compressive loading is reported in the JCCA(Dec/02) and was supervised by Dr. Greg Kawchuk.www.jcca-online.org

• Dr. Shari Wynd DC, (PhD candidate) in the AlbertaProvincial CIHR Training Program in Bone and JointHealth at the University of Alberta and University ofCalgary has been awarded a second year of funding inthis very specialized competitive CIHR program.

• Dr. Gotlib has been participating in a sub-committeeconvened by Dr. David Phipps PhD, Director of Part-nerships at the CIHR and has helped to extend thepartnership program for a 3 year period.

Many of the activities set out above, represent significant

milestones. Having the CIHR recognize and fund a CCAResearch Workshop for chiropractic researchers and thechiropractic profession not only brings tremendous cred-ibility, but provides opportunity to align our agenda withthe CIHR research agenda and place our profession andour researchers in a better position to effectively competefor millions of federal dollars available from CIHR toundertake “Chiropractic Research”.

CANADA’S NEXT UNIVERSITY-BASEDCHIROPRACTIC RESEARCH CHAIR

Dr. Mark Erwin DC, recently awarded Canada’s 2nd uni-versity-based Chiropractic Research Chair, is now follow-ing in the foot-steps of Dr. Greg Kawchuk DC, PhD.Currently he is a PhD candidate at the Institute of MedicalScience, Faculty of Medicine, University of Toronto andhe is set to take up the Chair in Phase II of the CIHRAward.

Dr. Erwin’s research project concerns the observationthat certain animals are spared from developing degenera-tive disc disease whereas others (including humans) arenot. There is a fundamental difference in the cellpopulations of the disc nucleus amongst these speciesdifferences and Dr. Erwin has relentlessly investigatedwhat these differences are and how they function. He hasnow identified certain species of proteins produced bythese cells of interest and has evaluated expression ofimportant genes unique to chondrogenesis. His goal is tosome day be able to treat degenerative disease of cartilagematrix at the molecular level so as to slow down, reverse oreven prevent degenerative disc disease. The notion ap-peals to him because it is a clinical problem that faces allhealth-care disciplines and brings together many fields ofstudy including histology, pathology, physiology, biome-chanics, clinical epidemiology, surgery, rheumatology,genetics and molecular biology.

He is completing his doctoral work this November andpreparing for his post-doctoral training. He hopes to beable to help mentor other investigators yet to come andmake their path a little easier since he thinks that he’s madeall of the mistakes possible. As the next university-basedChiropractic Research Chair in Canada he is “delightedbeyond words” and is “grateful to the CCA, CCRF, OCAand CIHR and feels privileged to join Dr. Greg Kawchukin this honour”.


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Dr. Erwin’s award is funded by the Ontario ChiropracticAssociation and the Canadian Institutes of Health Re-search and represents a $300,000 investment in chiro-practic research.

Investing in people has been the driving principle of theCanadian Chiropractic Association (CCA), and the Cana-dian Chiropractic Research Foundation (CCRF), and nowthe Ontario Chiropractic Association (OCA) who havejoined the national program. The Ontario ChiropracticAssociation has provided a wonderful opportunity to fos-ter the development of our intellectual research capacity.By supporting university-based chiropractic researchersand in particular this Chiropractic Research Chair, theyprovide opportunities for chiropractic researchers to as-sume leadership roles and mentor future young research-ers. Collaborative approaches enable our integration intothe health care system and the university system and theOCA is to be commended for such leadership.

INVESTING IN “PEOPLE”HAS PAID BIG DIVIDENDS.

DEVELOPING A RESEARCH CULTUREIN CHIROPRACTIC

We are starting to see the seeds we planted years ago beginto blossom. The CCA had the foresight and leadership toplan for the future – a future secured through chiropracticresearch undertaken by chiropractors who are fulltimeuniversity-based researchers and who will trail blaze thepath for future chiropractors.

Our strategies of building relationships with federalgranting agencies, universities, and research organiza-tions, based on trust and credibility, advances our integra-tion into Canada’s health care system. We have “investedin people”. University-based research is consistent withboth The CCA Mission Statement and our new Vision.The CCA and the CCRF have excellent working relation-ships with CIHR and the Canadian Cochrane Network.We have established Canada’s 1st university-based Chiro-practic Research Chair at the University of Calgary andprovided the opportunity for our 2nd Chair most likely atthe University of Toronto. We have plans for many moreChairs across Canada. We have a university-based Re-search Consortium that is growing and we facilitate a bi-

annual world class Research Symposium. Our ConsortialNetwork is beginning to build multi-institutional workingrelationships. Look at the two Consortial NetworkProjects.

We are establishing linkages with the University ofBritish Columbia, University of Alberta, University ofCalgary, University of Toronto, University of Quebec atTrois-Rivière, University of Québec at Montreal, LavalUniversity, University of Guelph and building strong col-laborative relationships.

The vision of The Canadian Chiropractic Association isfor every Canadian to have full and equitable access tochiropractic care.

What better way than throughuniversity-based research!

All of these activities have created our viable researchculture and it is absolutely essential that we continue tonurture its growth.

CIHR AWARD RECIPIENTS

Our list continues to grow and we are delighted for thesuccess that these researchers have enjoyed.

Dr. Carlo Ammendolia DC, MSc,University of Toronto,Institute of Medical [email protected]

Dr. Jean-Sébastien Blouin, DC, MSc, PhD candidate,CIHR Fellowship award at Laval University funded bythe CIHR and La Fondation Chiropratique du Québec(FCQ)[email protected]

Dr. Jason Busse DC, MScCIHR Fellowship 2003McMaster [email protected]

Dr. Pierre Cote DC, PhDCIHR New Investigator Award 2003University of [email protected]



Dr. Mark Erwin DCCCA/CIHR/CCRF/OCA Senior Research Fellowship/Chiropractic Research Chair 2003 (Phase II)University of [email protected]

Dr. Jill Hayden DCCIHR Fellowship AwardUniversity of [email protected]

Dr. Greg Kawchuk DC, PhDCCA/CIHR Chiropractic Research ChairUniversity of [email protected]

Dr. Annalyn Mercado PhDCCA-CIHR Doctoral Research AwardUniversity of [email protected]

Dr. Jeff Muir DC, MScCIHR Fellowship 2002McMaster [email protected]

Dr. Jeffrey Quon DC, MHScCIHR FellowshipUniversity of British [email protected]

Dr. Gabrielle van der Velde DCCIHR FellowshipUniversity of [email protected]

Dr. Shari Wynd DCAlberta Provincial CIHR Training Program in Bone andJoint Health at the University of Alberta and Universityof [email protected]

CANADIAN CHIROPRACTICRESEARCH FOUNDATION

I want to thank all of the provinces and in particular,Alberta, British Columbia, Saskatchewan and New Bruns-wick, for their longstanding and continued support of theCCA with their substantial contributions to the CCA/CCRF national research program. They have set the stagefor our continued success and on behalf of the CCA, theCCRF, the profession and our researchers, I sincerelythank each of them for their commitment to our goals.

Recently, Manitoba and Ontario have partnered with theCCRF and provided tremendously significant funding.The CCA in concert with the CCRF, uses these funds andthose of other stakeholders, to leverage significant oppor-tunities such as creating and funding additional university-based Chiropractic Research Chairs such as Canada’supcoming 2nd Chiropractic Research Chair – Dr. MarkErwin. Our goal of building research capacity throughstrategic relationships such as the historic partnershipswith the CIHR will better position chiropractic researchand researchers and ensure long term growth and profes-sional survival.

As you can see, the Foundation has been quite busy thispast year facilitating new university-based ChiropracticResearch Chairs especially in Toronto and hopefully inHalifax, Calgary, Winnipeg and also in Quebec. As well,our funding sources are increasing and provincially wewelcome Manitoba and Ontario this year.

In Manitoba, Dr. Martin Gurvey (Winnipeg), a CCRFDirector, and Dr. Greg Kawchuk (Calgary) recently madea tremendous presentation to the Annual Membershipmeeting in Manitoba in an effort to restore Manitoba’sprevious level of research funding ($100 per member peryear) and they were successful. This represents an addi-tional $22,000 per year directed to the CCRF in support ofchiropractic research initiatives. They are to be congratu-lated for their success. We commend the Manitoba Chiro-practors’ Association and all Manitoba chiropractors fortheir commitment to research.

In Ontario, the Ontario Chiropractic Association hascommitted to partnering with the CCRF and CIHR insupport of our upcoming 2nd university-based Chiro-practic Research Chair with $38,000 per year for 4 years.We are enormously thankful to the OCA and all 3000Ontario chiropractors for their support.


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Fundraising events have also been tremendous. I ampleased to report that the Foundation has received a$15,000 donation from the proceeds of a golf tournamentin Calgary this summer organized by the Calgary Chiro-practic Society and the Rodin Law Firm. Their next tour-nament is September 14, 2003 at Valley Ridge GolfCourse and they are shooting for $20,000 this year. Ourplans are to develop similar venues across Canada tosupport chiropractic research.

The Edmonton Chiropractic Society Run/Walk forChiropractic Research raised $3500. This year the Societyis hosting the 2nd Annual Backs in Action Run/Walk onJuly 6, 2003 with proceeds going to the Canadian Chiro-practic Research Foundation.

The CCA’s endorsement program with Johnson Inc.provided $2340 for the last 6 months period of 2002 alone,with proceeds going to the CCRF.

Just some of the Foundation’s current funding commit-ments in 2003 include:

• Dr. Jeff Quon at the University of British Columbia in aCCRF, CIHR, British Columbia College of Chiro-practors partnership.

• Dr. Walter Herzog at the University of Calgary in aCCRF and College of Chiropractors of Alberta partner-ship.

• Dr. Greg Kawchuk at the university of Calgary in aCCA, CIHR, FCER, CCRF partnership.

• Dr. Mark Erwin at the University of Toronto in a CCA,CCRF, CIHR, Ontario Chiropractic Association part-nership.

Our relationship with CIHR has been fruitful and mustbe continued because it builds our profession’s credibilityand trust with government.

I invite all Canadian chiropractors to become mem-bers of the CCRF. Your $125.00 membership fee supportsso many worthy projects and is vital to our profession’sgoals. Become a part of this Foundation and help us grow!The Foundation would like to raise $1 million per year inorder to maximize its leveraging opportunities. While weare getting on the bases, we need to hit a home run! Pleasesupport the Foundation. All of your donations are taxdeductible.

• Dr. Robert Allaby• Dr. Emily Anderson• Ms Janet C.

Blanchard-Conn• Dr. Luke Boudreau• Dr. Jason Busse• Dr. Dwight Chapin• Dr. Jeffery Charron• Dr. Dena Churchill• Dr. Ivone De Marchi• Dr. David F. Dunn• Dr. Elaine Eglin• Dr. Dale Forsythe• Dr. Chris Garwah• Dr. Martin Gurvey• Dr. Robert J. Hasegawa• Dr. Ryan J Hoover• Dr. Patti Hort• Dr. Ross Hoshizaki• Dr. Eric Jackson• Dr. Susan Joshi• Dr. Bob Kariatsumari• Dr. Rahim Karim• Dr. Larry T. Kinakin• Dr. Bruce Kleinknecht• Dr. Mark Labreque• Dr. Todd Lizon• Dr. Shannon Miller• Dr. Edward K. Mah• Dr. Kevin Mahoney• Dr. Donald Millar• Dr. David Lovsin

• Dr. Evangelos Mylonas• Dr. Alma Nenshi• Dr. Lynette Nissen• Dr. Timothy Peloso• Dr. Irene Pennimpede• Dr. Mark Perrett• Dr. Dave Peterson• Dr. David Reinhart• Dr. Ivan Rostotski• Dr. Travers Roy• Dr. Preet Sehmi• Dr. Kristine Self• Dr. Christa Shahrokh• Dr. Wayne F. Singleton• Dr. Andrew Somogyi• Dr. W. Allen Smith• Dr. Richard Smolen• Dr. Dean Summers• Dr. Natalya Telenchenko• Dr. Hans Teschl• Dr. Kathryn Tessier• Dr. Mark Timmins• Dr. Gabrielle

Van Der Velde• Dr. Herb Vear• Dr. Jen Walraven• Dr. Shannon Wandler• Dr. Ronald Warkman• Dr. Kenneth Wilson• Dr. Dean Wright• Dr. Kenneth Zachkewich

The contributions of these new Foundation membersare immensely appreciated and tremendously helpful.Thank you!!

If each of Canada’s 6000 chiropractors was a memberof the Foundation, collectively we would have $750,000dollars to leverage.

And just imagine if we all committed $500 dollars to theFoundation – that’s $3 million to leverage. Two of ourcurrent members have made that extraordinary commit-ment to the Foundation and this moves us that much closerto a university based Chiropractic Research Center of

Our Research Foundation continues to grow and we aredelighted to welcome these new 2003 members:



Excellence. Are you getting excited yet!!!If you would like to become a member please send Dr.

Allan Gotlib an email request for a membership appli-cation and help us continue to provide critical fundingto our chiropractic researchers and our research [email protected]

PLEASE JOIN US AND HELPCATAPULT OUR PROFESSION

DR. JEFF QUON DC, MHSc,PhD candidate – UPDATE

Dr. Jeffrey Quon is in his third year of doctoral studies inthe Department of Health Care and Epidemiology, Facultyof Medicine, at the University of British Columbia (UBC).He completed all of his required coursework in the springof last year and then successfully sat his comprehensiveexamination in the fall. Earlier this year he had his thesisproposal approved by the thesis screening committee in hisdepartment and has since been officially ‘Admitted toCandidacy’ at UBC.

Dr. Quon’s thesis research will examine the effect of thetiming of surgery on postoperative outcomes in patientswith lumbar disc herniation (LDH). Studies to date pro-vide limited evidence of an association between symptomduration and postoperative outcomes, however the inde-pendent effect of the timing of surgery still needs to beverified and described in terms of psychometrically vali-dated outcome measures while also controlling for otherimportant prognostic variables. If an independent effect oftiming is identified, this will help to define an optimumwindow within which surgery is most appropriate forpatients with LDH. Moreover, in this age of constrainedhealth care resources and lengthy surgical wait lists, suchinformation will better determine when (or if) lumbardiscectomy can be deferred indefinitely for patients withsymptom durations exceeding a window for optimum ben-efit. On the other hand, if the timing of surgery is found notto influence postoperative outcomes, patients and clini-cians can be reassured that there is never a point in rushinginto an operation in the absence of other existing evidencebased criteria for surgery.

Dr. Quon’s thesis research will also be quantifying theeffect of surgery on work productivity and other occupa-tional outcomes. Recent studies have demonstrated that

interventions that result in successful functional/clinicaloutcomes do not necessarily lead to improvements in tradi-tional measures of work status. Time to return-to-work, forexample, is easy to extract from administrative datasources and personnel records, however this measure doescapture the full impact of health or disability on an indi-vidual’s on-the-job performance. Furthermore, the return-to-work concept does not distinguish the degree to whichabsence from work is due to job dissatisfaction, excessiveworkload and/or personnel policies that support takingtime off from work, rather than diminished health/func-tional status alone. There is an urgent need for the develop-ment of multidimensional work outcome measures thatmore appropriately capture the social and psychologicaldeterminants of return-to-work, and which capture the fullimpact of health on an individual’s actual productivitywithin the workplace.

Dr. Quon will also be looking at how work-relatedoutcomes are affected by other variables, including dis-ability compensation, occupation and chiropractic treat-ment. Finally, he is also collaborating on a separate pro-posal for a study to examine the effectiveness ofchiropractic treatment for acute neck pain in a specializedemergency room setting. This proposal is still in the con-ceptual phase, but may involve a randomized controlledtrial comparing a single chiropractic visit in the emergencyroom to a single emergency physician visit in the samesetting. Researchers from the Department of EmergencyMedicine at Vancouver General Hospital are interested indetermining whether chiropractic manipulative therapy isassociated with averted complications from drug therapy,effective on-the-spot pain relief, and greater patient satis-faction.

Dr. Quon is a CIHR Fellowship recipient, a 3 yearaward which is supported by CIHR, Canadian Chiro-practic Research Foundation and the British ColumbiaCollege of Chiropractors.

LA FONDATION CHIROPRATIQUE DU QUÉBEC

The Fondation chiropratique du Québec, has taken greatstrides to advance chiropractic research in Quebec and hasfostered some wonderful opportunities for which they areto be congratulated.

The Foundation has some 200 members and corporatedonors which provides support to such researchers and


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projects as: Dr. Jean Boucher PhD at UQAM working on“the effect of the chiropractic adjustment at the level of thecentral nervous system”, and Dr. Christian Linar of UQTRwho is working on the effect of the chiropractic adjustmentupon the molecular marker in the gastro-intestinal tract,and Dr. Jean-Sebastien-Blouin, a PhD candidate at Lavalwho holds a CIHR/FCQ partnered Fellowship award.

The Fondation has an excellent collaborative relation-ship with the CCRF. Congratulations to Dr. Guy Beau-champ and his Board members.www.fcq.qc.ca

CONSORTIUM OF CANADIAN CHIROPRACTICRESEARCH CENTERS (CCCRC)

SymposiumThe CCA and CCRF will facilitate the 4rd symposium bysponsoring the event in concert with the Consortium thatwill once again be host. The Call for Abstracts will be sentout this fall. Consortial members will be presenting theirlatest research. Contact Dr. Jean Boucher PhD, who is theconvenor, at [email protected] for early informa-tion regarding the symposium scheduled for October 2004in Quebec. Don’t miss this essential symposium.

ADVANCING CHIROPRACTIC RESEARCHERS

Recent PhD’s

Dr. Pierre Côté DC, PhD,Newly appointed Assistant Professor, Department of Pub-lic Health Science, Faculty of Medicine, University ofToronto, and Scientist, Institute for Work and Health, andAssistant Editor, [email protected]

Dr. Annalyn Mercado PhDUniversity of [email protected]

PhD candidates

Dr. Carlo Ammendolia DC, MSc University of Toronto,Institute of Medical [email protected]

Dr. Jean-Sebastien Blouin DC, MScUniversité [email protected]

Dr. Martin Descarreaux DC, MScLaval [email protected]

Dr. Mark Erwin DC, MScUniversity of [email protected]

Dr. Jill Hayden DCUniversity of [email protected]

Dr. Kevin McLaughlin DC, MScUniversity of New England,New South Wales, [email protected]

Dr. Jeff Quon DC, MHSc,University of British [email protected]

Dr. Bruce Symons DC, MScUniversity of [email protected]

Dr. Gabrielle van der Velde DCUniversity of [email protected]

Dr. Howard Vernon DC,University of Glamorgan,Cardiff, Wales, United [email protected]

Dr. Shari Wynd MASc, DCUniversity of [email protected]

Recent Master’s

Dr. Francois Hains DC, MScUniversity of [email protected]



Dr. Doug Lawson BA, DC, MScFaculty of Medical ScienceUniversity of [email protected]

Dr. Justin Marcotte DC, MScUniversité du Québec à Trois-Riviè[email protected]

Masters candidates

François Auger, DCUniversity of Quebec in Montreal

Sophie Boulianne, DCUniversity of Quebec in Montreal

Dr. Jason Busse DC, MScMcMaster [email protected]

Dr. John Dufton DCUniversity of British [email protected]

Dr. Diane Forbes DCUniversity of British [email protected]

Dr. Drew Oliphant DC, FCCO(C)Royal Melbourne University (Austr) and SouthernCalifornia University of Health [email protected]

Jean-Roch Pinette, DCUniversity of Quebec in Montreal

Dr. Mark Pitcher DCMemorial University of [email protected]

Dr. Nadia Richer DCLaval Université

Congratulations to these dedicated clinicians who aremaking extraordinary commitments to our profession andare our profession’s future researchers.

If you have a Masters Degree or a PhD and you are notlisted above, please let Dr. Allan Gotlib know. He isdeveloping a database for a variety of purposes and itwould be helpful.

STUDIES/PROJECTS UNDERWAY

Please see Bulletin #7 for an in depth description of ongo-ing projects which have been previously reported.www.ccachiro.org

Ammendolia Bombardier Hogg-Johnson Glazier“Views toward radiography use in acute low back painamong chiropractors in an Ontario community”. Update:published JMPT 2002 Oct;25(8):[email protected]

Ammendolia Bombardier Hogg-Johnson Glazier“Implementing evidence-based guidelines for x-ray use inacute low back pain. A chiropractic community interven-tion. Update: accepted [email protected]

Ammendolia Bombardier Kerr and the Canadian TaskForce on Preventive Health Care.“The use of back belts for the prevention of occupationallow back injuries”. Update: submitted Can Med Ass [email protected]

Biggs“Professional Identities of Chiropractors”[email protected]

BishopThe project entitled “Outcome evaluation of the manage-ment of lumbar disc protrusion causing sciatica” is a pro-spective cohort study. The primary question was, do pa-tients with lumbar disc protrusions causing radiculopathyhave a significant improvement in their disease-specifichealth-related quality of life (HRQOL) as assessed by theNeurogenic Symptom Scale of the North American SpineSociety (NASS) Instrument at six months postoperatively?Co-investigators include Fisher, Fairholm, Dvorak, Wing,Wright, and Robens-Paradise. Funded by the RegionalEvaluation of Surgical Indications & Outcomes (RESIO)and presented at the North American Spine Society Meet-ing, October, 2001. Update: This project was part of a


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larger prospective observational study looking at severalpotential predictors of outcome from the surgical and non-surgical management of lumbar disc protrusion causingsciatica. This particular project involving HRQOL and theNASS instrument has been accepted for publication [email protected]

BishopThe project entitled “Implementation of clinical practiceguidelines in Worker’s Compensation Board patients withacute mechanical back pain: a prospective randomizedtrial” assessed the degree to which the patterns of practiceof primary care physicians in managing the WCB patientsare in compliance with current practice guidelines and alsodetermined whether providing family physicians and theirpatients with the guidelines would alter the degree ofadherence. Co-investigators include Wing and Badii.Funded by the Worker’s Compensation Board of B.C.Update: This study has concluded. The results were pre-sented at the NASS Meeting in Montreal in October, 2002.The first paper from this study has been accepted forpublication in The Spine [email protected]

Bishop NewThe project entitled, “Prospective Randomised DoubleBlind Controlled Trial of Selective Nerve Root Blockadein Patients with Acute or Subacute Sciatica” is ongoingand will determine if SNRB with steroid is effective inimproving functional status in this patient group. Second-ary objectives include determining if SNRB is effective inimproving quality of life or rates of progression to surgery.Additional objectives are to examine whether baselinecharacteristics such as duration of symptoms, findings onCT or MRI and initial response to injection can influencethe final outcome or predict the response to SNRB. Thedesign is a single centre, parallel design, prospectiverandomized, double blind, placebo-controlled trial. Theprimary outcome of interest is functional improvement insix weeks as defined by changes in modified Roland Dis-ability scores from baseline. Co-principal investigators arePaul Bishop and Maziar Badii, MD, FRCP (Rheumatol-ogy). Funding of $262,000 by the Worker’s CompensationBoard of [email protected]

Blouin Descarreaux“Whiplash injuries: from stabilization mechanisms to sen-sorimotor deficits”[email protected]

Blouin Corbeil“Influence of muscular fatigue on the postural controlsystem”[email protected]

Blouin Descarreaux Simoneau“Roles of vestibular and cervical proprioceptive signalsfor on-line space updating”[email protected]

Corbeil Blouin Bégin Nougier Teasdale“Perturbation of the postural control system induced bymuscular fatigue” In this experiment, we induced muscu-lar fatigue of ankle plantar-flexors to examine how itdeteriorates the regulation of bipedal quiet upright stand-ing. Postural stability was assessed in conditions with andwithout vision over 60 s period to examine not only classi-cal postural variables (time- and frequency-domain analy-ses), but also structural variables (stabilogram-diffusionanalysis). With muscular fatigue, subjects exhibited anincreased postural sway (faster center of pressure (CP)velocity, and greater CP mean and median frequency) anda decreased long-term scaling exponent compared with thecontrol conditions. These results suggest that fatigue didinduce some changes in the control mode of posturalstability, but the detection/action capabilities of the senso-rimotor system remained partly efficient when the ankleplantar-flexors were fatigued. Furthermore, the decreasedlong-term scaling exponent observed with fatigue suggeststhat the control of upright stance operates in a lessstochastic and more antipersistent manner when fatigue ispresent (i.e. past and future behaviors were more nega-tively correlated and thus more tightly regulated). Alto-gether, the present results suggest that fatigue placeshigher demands on the postural control system by increas-ing the frequency of actions needed to regulate the uprightstance. This study has been accepted for publication inGait & Posture and is available online at http://www.elsevier.com/locate/issn/09666362



BoucherThe project entitled “transcranial magnetic stimulation” isan ongoing investigation and several publications comingout of this work have been accepted by JMPT and will bepublished very shortly. Dr. Jean Boucher PhD is a consor-tial network member and is based at the University ofQuebec at [email protected]

Boudreau McBride“Chiropractic Services in the Canadian Military: a pilotproject”[email protected]

Busse Guyatt Bhandari Cassidy“A 4-part series on a user’s guide to the chiropracticliterature” Update: The first two articles in this series,discussing how to use an article about therapy, have beenaccepted for publication, and the first will appear in JMPTthis [email protected]

Busse Bhandari, Guyatt, Morrow, Siddiqui, Leighton, andSchemitsch.“A systematic overview and meta-analysis examining op-erative versus non-operative treatment of acute achillestendon ruptures”. Update: published in Clinical Ortho-pedics and Related Research 2002;400:190–[email protected]

BusseFollowing the recent publication of a meta-analysis inves-tigating the effect of low intensity, pulsed ultrasound ontime to fracture healing (Busse JW, et al., CMAJ. 2002;166: 437–441). Update: A pilot project grant has beencompleted and will be submitted to CIHR this summer. Six(6) North American university-based orthopaedic depart-ments have agreed to recruit patients for the pilot project,and Smith & Nephew has agreed to provide $400,000.00in ultrasound equipment to support both the pilot projectand the definitive trial. Current co-investigators areGuyatt, Bhandari, Stephen, Mandel, Sanders, Heckman,Swiontkowski, and [email protected]

Busse Kulkarni, Campbell, Injeyan“A survey of Canadian chiropractic students examiningattitudes towards vaccination” published in. CanadianMedical Association Journal 2002;166:1531–1534. Up-date: A subsequent paper that presents a critical analysisof common anti-vaccination arguments has been acceptedfor publication by JMPT. Campbell and Morgan were co-participants in this [email protected]

Busse Bhandari“A database analysis to examine predictors of morbidityand mortality for emergency trauma surgery”. Update:We reviewed records on all trauma patients, except thosewith moderate to severe burns, who presented to a Univer-sity-affiliated level one trauma centre and underwent sur-gery, from 1995 until 2001 (n=1044). Factors predictive ofincreased mortality were higher Injury Severity Score(odds ratio [OR] 1.07; 95% confidence interval [CI] 1.03-1.08), older age (OR 1.04; 95% CI 1.03-1.07), operationsinvolving the cardiovascular system (OR 1.67; 95% CI1.09-2.57), and operative procedures coded as “miscella-neous” (OR 1.77; 95% CI 1.06-2.94). Time of presentationfor emergency trauma surgery was not associated withdifferences in either major complications or mortality. Co-participants were Bhandari and Devereaux, and this studyhas been submitted for [email protected]

Busse NewWe conducted a two year prospective observational cohortstudy to evaluate health-related quality of life, using theSF-36 and a visual analogue pain scale, in thirty patientswith unstable ankle fractures who were otherwise healthy.Smoking history, presence of a medial malleolar fractureand lower levels of education were significant predictorsof lower physical function. Lower mental health domainscores were significantly associated with alcohol use andincreasing age. Co-participants were Bhandari, Sprague,Hanson, Dawe, Moro, and Guyatt GH. This study has beensubmitted for [email protected]

Busse NewThere exists current debate as to the potential impact ofindustry funding on research findings. We therefore exam-


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ined whether there was an association between reportedindustry funding and authors’ conclusions among a con-secutive sample of 332 randomized medical and surgicaltrials acquired from 13 leading journals. Our analysis,controlled for study quality and sample size, demonstratedan association between industry funding and the likelihoodthat a trial will have statistically significant pro-industryresult (odds ratio [OR] = 1.91 95% confidence interval[CI] = 1.3-3.5). Co-participants were Bhandari, Jackow-ski, Montori, Schünemann, Sprague, Mears, Schemitsch,Heels-Ansdell, and Devereaux. This study has been sub-mitted for publication. This study was awarded first prizeat the McMaster Orthopaedics Research Day and will bepresented by Dr. Busse at the 3rd joint meeting of theInternational Society for Clinical Biostatistics and the So-ciety for Clinical Trials in London, UK, this [email protected]

Busse NewThere is evidence to suggest that Whiplash AssociatedDisorders (WADs) are influenced by physical trauma andpsychosocial factors, as well as by medicolegal and com-pensation systems. In this project, entitled “The Impact ofnon-Injury Related Factors on Disability Secondary toWhiplash Associated Disorder Type II: A RetrospectiveFile Review”, we examined a consecutive sample of pa-tients presenting to a single chiropractors office, withWAD type II, on disability, who had declared if they hadretained a lawyer (n = 33). Our analysis found that higherself-reported disability on initial assessment (NDI) wasassociated with female gender, and in particular by retain-ing a lawyer. Large prospective studies are needed toestablish the validity of these findings. Co-participantswere Dufton, Kilian, and Bhandari, and this study has beensubmitted for [email protected]

Busse NewThis project, entitled: “Therapeutic Ultrasound and Frac-ture Healing: A Survey of Beliefs and Practices” examinedthe attitudes of 25 orthopaedic surgeons and 34 seniorphysiotherapy students at a single university. Thirty-twopercent of surgeons felt that ultrasound was contraindi-cated and harmful to healing fractures or of no use, and20.5% of senior physiotherapy students reported the beliefthat ultrasound was contraindicated and was, or may be,

harmful to healing bone. Current usage of this modality israre primarily due to the perceived lack of evidence andlack of availability. Large randomized trials are needed tofurther define the role of ultrasound on fracture healing.Bhandari was a co-participant, and this study has beensubmitted for [email protected]

Busse NewThis project, entitled “Influence of Authorship Order onPerceptions of Authors’ Contributions” sought to evaluatewhether there is variability in the perception of authors’contributions to research based upon authorship orderamong a group of experienced readers (Chairpersons inthe departments of surgery and medicine at all 16 medicalprograms in Canada.). We found that in the absence ofexplicit reporting of authors’ roles in published researchpapers, there remains considerable variability regardingperceptions of each author’s contribution. First and lastauthors of published reports are perceived to have greaterroles. Co-participants were Bhandari, Kulkarni, Devere-aux, Leece, and Guyatt GH. This study has been submittedfor [email protected]

Busse NewThe validity of some exposure syndromes, such as multi-ple chemical sensitivity, attributed to the influence of toxicenvironmental chemicals, is uncertain. Diagnosis is sub-jective, and standard medical treatment often fails. Exist-ing evidence suggests that in many individuals with thesesyndromes, psychosocial factors play a prominent role. Inthis project we present an approach to managing patientspresenting with sensitivities to environmental agents thatincludes identifying and managing organic disease, ob-taining a thorough biopsychosocial history, confirming adiagnosis, and developing a rehabilitative process thatfocuses on support and improvements in function. Co-participants were Reid, Leznoff, Barsky, and Guyatt. Thisstudy has been submitted for [email protected]



Cassidy Haldeman, Nygren, Schubert, Carroll, Côté,Peloso, Hurwitz, Nordin, Bombardier, Maetzel, Salmi,Dvorak, Bogduk and Hogg-Johnson“WHO Collaborating Center Task Force on Neck Pain andIts Associated Disorders”. [email protected]

Cassidy, Haldeman, Nygren, Schubert, Carroll, Côté,Peloso, Hurwitz, Hogg-Johnson, Nordin, van der Velde,Beaton, Bracher, Carragee, Grier, Johnson, Johnson,Bombardier, Maetzel, Salmi, Dvorak, Morgenstern,Weinstein, Krahn and Bogduk.Decade of the Bone and Joint 2000–2010 Task Force onNeck Pain and Its Associated Disorders: This is a best-evidence synthesis of the world literature on neck pain andits associated disorders and includes original researchprojects on complications of common treatments, a formaldecision analysis, and an occupational cohort study. Thetask force will propose patient-care guidelines based onthis work. Major funding comes from the CCPA, NCMICand other [email protected]

Cassidy“Clinical Prediction Rules in Whiplash-Associated Disor-ders”. The is a five-year program of research aimed atdeveloping and validating clinical predictions rules forwhiplash-related neck pain, low-back pain, temporoman-dibular disorders, headache and concussion after trafficcollisions. Two population-based studies of traffic injuriesin Saskatchewan will provide the training and test datasets. Funding is from the Alberta Heritage Foundation forMedical Research through a Health Scholar Award for [email protected]

Cassidy, Carroll, Côté“An Outcomes Assessment of Rehabilitation Program forTraffic Injuries in Saskatchewan”. This is a population-based assessment of a government funded rehabilitationnetwork to treat traffic injuries. Funded by SaskatchewanGovernment [email protected]

Cassidy, von Holst, Nygren, Carroll, Borg, Holm, Peloso,Kraus, Yates, Ericson, Coronado, Pépin, Schubert, andPaniak.“WHO Collaborating Centre Task Force on Mild Trau-matic Brain Injury”. This is a six-year initiative by aninternation task force to complete a best-evidence synthe-sis and original research on the topic of mild traumaticbrain injury. The results of the task force will be presentedat the 5th World Congress on Brain Injury in Stockholm inMay 2003 and published later in 2003. Funding is from theInsurance Corporation of British Columbia, SaskatchewanGovernment Insurance, La Sociétié de l’assurance auto-mobile du Québec, AFA Insurance, Sweden; FolksamInsurance, Sweden; the Volvo Car Company, Sweden; andTrygg-Hansa, [email protected]

Côté, Johnson, Baldwin, Frank“The Arizona State University Healthy Back Study: Astudy of the cost effectiveness of chiropractic versus medi-cal care in returning injured workers with occupationallow back pain to work”. Update: An abstract of this paperwill be presented at Forum VI for Primary care Researchon Low Back Pain on May 22–24, 2003 in Linkoping,Sweden. Dr. Côté is Scientist at the Institute for Work andHealth and an Assistant Professor of Public Health sci-ences at the University of [email protected]

Côté“The epidemiology and primary care utilisation for occu-pational neck pain in Ontario”. Update: The researchteam is now forming the cohort of injured workers fromthe WSIB database. Funding ($139.950) is from the On-tario Ministry of Health and Long Term Care/OntarioChiropractic [email protected]

Côté“Is the choice of care provider associated with healthoutcomes after whiplash?: A study of whiplash in a cohortof traffic injury claimants in Saskatchewan”. Update:This project is completed and the paper has been submittedfor [email protected]


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Côté NewThe project entitled “The Incidence and Course of NeckPain in the General: A Population-based Cohort Study” isusing data from the Saskatchewan Health and Back PainSurvey to describe the incidence and natural history ofneck pain. This study uses data from 1131 Randomlyselected adults from Saskatchewan who were followed-upfor one year. Funding of the project was provided by theChiropractors’ Association of Saskatchewan and Sas-katchewan Health. Co-investigators are Cassidy, Carrolland Kristman. An abstract of this study will be presented atthe Canadian Society for Epidemiology and BiostatisticsBiennial Meeting in Halifax, Nova Scotia, June 8–11,2003.

A paper from the Saskatchewan Health and Back PainSurvey: Carroll L, Cassidy JD, Côté P. Factors associatedwith onset of an episode of depressive symptoms in thegeneral population. 2003 is currently in press in the Jour-nal of Clinical Epidemiology.

Crawford Dawson Tiidus Pierrynowski Trotter“Evaluation of a Community-Based Exercise Program forDiminishing Symptoms of Fibromyalgia”. Published inPhysiotherapy Canada 2003;55(1):17–22.

Normand Descarreaux Black Poulin Richer Dugas“Biomechanical effects of a lumbar support in a mattress.J Musculoskeletal Research (in press)[email protected]

Blouin Descarreaux Bélanger-Gravel Simoneau Teasdale“Human neck muscles attenuation following imposedtrunk forward acceleration”. Experimental Brain Research(in press)[email protected]

Descarreaux Blouin Teasdale“A non-invasive technique for measurement of segmentalsagittal neck motion”. European Spine Journal (in press)[email protected]

Blouin Descarreaux Bélanger Simoneau Teasdale“Self-initiating a seated perturbation modifies the neckpostural responses”. Neuroscience Letters (in press)[email protected]

Blouin Bresciani Cantin Sarlégna Blouin DescarreauxGauthier“Estimating gaze shifts through extraretinal, cervical andvestibular signals”. Experimental Brain Research (submit-ted)[email protected]

Descarreaux Blouin Teasdale“Force production parameters in low back pain subjectsand healthy control subjects”. Spine (submitted)[email protected]

Blouin Descarreaux Bélanger Simoneau Teasdale“Contribution of reflex- and voluntarily-triggered neckpostural responses for the stabilization of the head-necksystem”. Experimental brain research (submitted)[email protected]

Descarreaux Blouin Drolet Papadimitriou Teasdale“Efficacy of preventive spinal manipulation for chroniclow back pain and related disabilities. A preliminarystudy”. JMPT (submitted)[email protected]

DuftonThe project “Profiling the health of long term disabilityclaimants” aims to describe the rates of utilization forvarious health care services (chiropractic, medical, physi-otherapy) among workers who have had a long term dis-ability claim. Several provincial wide data sources arebeing linked to create a person-specific longitudinal data-base for this analysis. The co-investigator for this project isMieke Koehoorn PhD from the University of British [email protected]

DuftonThe project “Delayed recovery and chronic disability as-sociated with whiplash associated disorders” is a mastersthesis project. This study will examine clinical and non-clinical factors associated with delayed recovery after amotor vehicle collision. The research committee for thisproject consists of Jacek Kopec MD PhD, MiekeKoehoorn PhD, Hubert Wong PhD, all from the Universityof British Columbia, and David Cassidy DC, PhD from theUniversity of Alberta.



Dr. Dufton is a Masters Candidate funded by theMichael Smith Foundation for Health Research TraineeAward, a 2 year award at the University of British Colum-bia, Faculty of Medicine, Department of Health Care [email protected]

ErwinThe project entitled “Is the notochord cell the key tointervertebral disc homeostasis?” concerns particular as-pects of the physiology of the intervertebral disc. Theproject developed from the observation that certain speciesof dog do not develop degenerative disc disease whereasothers do develop the disease and do so at an early age. Theessential link in this observation is that the animals that donot develop degenerative disc disease maintain their resi-dent notochord cells within the nucleus pulposus of theintervertebral disc. The animals that are prone to the dis-ease (such as is the case with humans) lose these cells earlyin their life. The intervertebral disc nucleus pulposus origi-nally contains two types of cells; chondrocytes and noto-chord cells. Dr. Erwin has determined that the notochordcells produce soluble proteins that seem to target theproteoglycan synthesizing machinery of the chondrocytesand do so across species in a dose dependent fashion. Dr.Erwin is presently characterizing the specific nature andidentity of the proteins produced by the notochord cellsand examining specific genes that are ‘turned on’ in cellu-lar signaling events downstream. Dr. Erwin is the recipientof Canada’s 2nd university-based Chiropractic ResearchChair and he currently carries out his research at theToronto Western [email protected]

Hains Goulet RossignolThe project “Clinical examination and diagnosis ofchronic musculoskeletal neck pain: an inter-rater reliabil-ity study” evaluated the clinician’s ability to reliably iden-tify musculoskeletal signs and to reliably diagnose neckpain conditions based on clinical findings. The interraterreliability of chiropractic and medical judgements wasalso compared. Two physicians and two chiropractorsserved as examiners. After reviewing a history form filledout by each subject, they evaluated in random order, asample of chronic neck pain sufferers. The examinationincluded the assessment of (1) cervical ranges of motion

(ROM) , (2) muscle tenderness and spasm, (3) facet jointtenderness and (4) segmental motion dysfunctions. Basedon these findings, the examiners identified the presence orabsence of four related musculoskeletal signs and theyprovided a final diagnosis, using the Whiplash AssociatedDisorder classification, of grade 1 or 2 WAD. Thirty-nineadults participated in this study. No association was notedbetween pain intensity and presence of musculoskeletalsigns or diagnosis of grade 2 WAD. The inter-rater reli-ability of each sign and the final diagnosis was poor (ICC< 0.31). The clinical disagreement was similar betweenchiropractic and medical examiners. Clinicians could notreliably identify musculoskeletal signs and diagnose grade1 and 2 WAD. The definition of each sign should berefined. It appears justify clustering grade 1 and 2 WADinto a single category until clinicians can reliably distin-guish between the two. The WAD classification shouldalso take into account the evaluation of psychosocial fac-tors related to the development of chronic neck pain.

Hayden van Tulder“Exercise therapy for treatment of adult non-specific lowback pain”[email protected]

Hayden Tomlinson“Use of bayesian statistics in meta-analysis of heterogene-ous studies: a methodology review and example”[email protected]

Hayden Bombardier, Beaton, Hogg-Johnson“Measurement properties and feasibility of patient-reportoutcome measures in claim-based musculoskeletal reha-bilitation practice”[email protected]

Hayden Mior Verhoef“Evaluation of chiropractic management of pediatric lowback pain patients: A prospective cohort study”. publishedJMPT 2003; 26 (1):1–[email protected]

Hayden Bombardier, Beaton, Hogg-Johnson“Development of a framework to identify clinically usefulpredictive factors for low back pain”[email protected]


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Hayden NewThe project “Descriptive analysis of quality criteria used insystematic reviews of prognostic studies”, examines howprimary study quality has been assessed in published sys-tematic reviews of prognosis. Published articles wereidentified in Medline (1966 to March 2003) and referencelists of retrieved and other relevant articles. A total of 738articles were identified. Titles and abstracts were screenedfor inclusion/exclusion criteria; 120 articles were re-viewed in full. Included were systematic reviews of prog-nosis, which included quality assessment of the primarystudies. Seventy-two reviews were included; there waswide variation in quality assessment. Analysis includesuse of expert consensus to compile distinct, explicit de-scriptions of items, summarizing endorsement rates ofitems, and summarizing empirical evidence on the im-pact of quality items. This review will help develop muchneeded recommendations for quality assessment in ob-servational [email protected]

Herzog Symons“Immediate effects of SMT on VA histology”[email protected]

Herzog Suter McMorland“Reflex responses following spinal manipulative treat-ments”[email protected]

Herzog Drover“Muscle inhibition in competitive athletes with thigh mus-cle injury”[email protected]

Herzog Symons“Vertebral Artery mechanics during neck manipulativetreatments”[email protected]

Herzog Forand Drover Symons“Forces exerted by female and male chiropractors duringThoracic Spinal Manipulation”[email protected]

Kawchuk Oliphant‘Identification of Induced Annular Tears Using Diffusion-Weighted MRI in a Porcine Model’[email protected]

Kawchuk FauvelDevelopment of a Non-invasive Ultrasonic TechniqueCapable of Quantifying Vertebral Load-displacement Re-sponses into a Clinically Relevant [email protected]

Kawchuk“Ultrasonic Quantification of Spinal Displacements”[email protected]

Kawchuk“Identification of Intervertebral Disc Injury with DiffusionMagnetic Resonance Imaging”[email protected]

Kawchuk“Development of an Animal Model of Vertebral ArteryInjury”[email protected]

Kawchuk Smith“Effect of nucleus pulposus digestion on the mechanicalproperties of the intervertebral disc during staticcompressive loading”[email protected]

Kawchuk Perle“Radiographically determined anatomical location of thepoint of peak pressure during pisiform and hypothenarcontact manipulation procedures”[email protected]

LawsonThe project “Use of the Multifacet Rasch Model to Adjustfor the Error Variance Due to the Examiner Stringency/Leniency Effects in OSCEs” examines the decisions re-garding candidate competency / incompetency (pass/fail)for professional certification from “high stakes” ObjectiveStructured Clinical Skills Examinations (OSCEs) whichshould be both reliable and valid. Thus, it is necessary to



ensure that the scores contain minimal error variance in-cluding that due to judge stringency/leniency effects. Al-though judge variance has been found to be extensive inoral examinations, no studies have been done with OSCEs.OSCE scores are believed to contain insignificant amountsof error variance because of the use of structured check-lists, standardized patients, and trained judges. Investiga-tions on the use of dual judges at the same OSCE stationhave found high inter-rater correlations. However, thisdoes not guarantee that candidate scores will not be inap-propriately biased by judge stringency/leniency effects.The purpose of this study was to determine if the multifac-eted Rasch model (MFRM) of Item Response Theory(IRT) could be used to identify the presence and amount oferror variance due to judge stringency/leniency effects. Inaddition, the Classical Test Theory (CCT) and MFRMwere compared to determine which provided overall betteranalyses of candidate performance.

CCT provided some evidence of a judge stringent/leni-ency effect but IRT provided clear evidence of a largeamount of error variance due to judge stringency/leniencyeffects. In fact, for approximately 6% of the candidatesnear the pass/fail score, outcomes were changed. The IRTmethod was deemed to be more informative since it dealtwith the issues of unidimensionality and fit of data tomodel. No comparable data to model fit is necessary whenusing CCT. Although both methods of analysis require ahigh level of expertise to ensure appropriate analysis, IRTprovided far more useful information about the character-istics of the facets, plus it estimated candidate “true”scores by adjusting for judge stringency/leniency effects.The findings of this study should encourage others licens-ing bodies that use OSCEs with approximately 50–750candidates to explore the potentials of analyzing their datausing the multifaceted Rasch [email protected]

Marcotte Normand Black“Investigating the kinematics and kinetics of standardizedmotion palpation”[email protected]

McMorland Suter Verhoef Hurlbert“Randomized, controlled, double-blinded study whichwill investigate whether chiropractic care for patients suf-fering low back pain and leg pain secondary to lumbar

herniated disc will improve patient outcome and reducetreatment costs compared to back surgery”[email protected]

McMorland Suter“Alterations in muscle activation during the gait cycle inpatients with pelvic or lower extremity injury”[email protected]

McMorland Suter“Alterations in kinematics of the upper extremities, shoul-der girdle, pelvis, and lower extremities in patients withpelvic or lower extremity injury”[email protected]

McMorland Suter“Decrease in elbow flexor inhibition after cervical spinemanipulation in patients with chronic Whiplash Associ-ated Disorder”. Update: published Clin Biomech2002;17:541–[email protected]

McMorland Injeyan Russell Verhoef“Response rates for chiropractic surveys” . Update: JMPT(in press)[email protected]

Mercado“Coping behavior in people dealing with the chronic painexperience”[email protected]

MuirThe project: “The Effects of Ipriflavone and Curcumin onBone” is a pilot study, to determine the effects ofipriflavone and curcumin on bone. There is currentlyconflicting evidence as to the effectiveness of ipriflavoneat limiting post-menopausal bone loss and only prelimi-nary evidence suggesting curcumin positively affects bonemass. No studies exist evaluating the combined effects ofthese compounds nor their efficacy versus conventionaltreatments. Ovarectomized mice will be administered thecompounds ipriflavone and/or curcumin, either alone or incombination, and their effects compared using the follow-ing outcome measures: histomorphometric analysis, bio-chemical markers of bone turnover, dual-photon (DPA)


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and dual x-ray (DXA) absorptiometry-measured BMD,peripheral quantitative computed tomography (pQCT),magnetic resonance (MR) imaging and tensile strength. Subsequently, we hope to determine dose-dependency andtime-course characteristics, efficacy versus pharmaceuti-cal interventions such as hormone replacement therapy(HRT) and bisphosphonates, and the effect of additionalsupplementation with vitamin D, calcium, varying physi-cal activity, etc. The use of histomorphometry, markerassays, BMD and pQCT/MR imaging to evaluate the com-bined and comparative effects of ipriflavone and curcuminmarks the first time that their effects have been evaluatedin this way.

Dr. Jeffrey M. Muir, MSc, DC is a Research Fellow,Department of Nuclear Medicine, McMaster University,funded with a CIHR Fellowship. His Co-investigators areColin Webber, PhD and J.D. (Rick) Adachi, [email protected]

Pitcher“Rates of Neuromuscular fatigue and repeatability ofmeasurements of EMG and force using a prone isometriclumbar extension exercise”[email protected]

QuonThe project “The effect of the timing of surgery on postop-erative pain, quality of life and work outcomes in patientswith lumbar disc herniation (LDH)” is a thesis project. Thestudy population will consist of lumbar disc patientstreated surgically through the Combined Neurosurgicaland Orthopaedic Spine Program at Vancouver GeneralHospital in Vancouver. The study will attempt to identifythe optimum timing of surgery (in terms of preoperativesymptom duration) and will also determine how, orwhether, postoperative outcomes are modified by com-pensation status. Additionally, health services utilizationinformation on all subjects will be acquired by way ofadministrative data, accessed through the BC LinkedHealth Data Base. Dr. Quon is a CIHR Fellowship recipi-ent and a PhD [email protected]

QuonThe project “A descriptive study of the prevalence of lowback pain among Nepalese porters” is nearing completion.

Co-investigator Steven Fedder, M.D., is a former volun-teer physician for the Himalayan Rescue AssociationMedical Clinic in [email protected]

QuonThe project “A descriptive study of emergency departmentpatients’ attitudes toward complementary medicine, andtheir willingness to participate in complementary and al-ternative medicine research was funded by the VancouverHospital Health Sciences Centre and the BC Health Re-search Foundation. The co-investigator R. Abu-Laban,M.D., is Research Director, Department of EmergencyMedicine, Vancouver General Hospital. The results of thisstudy were recently published in the Canadian Journal ofEmergency Medicine (CJEM 2002;4:407–7)[email protected]

QuonThe project “The Reliability and Responsiveness of Occu-pational Role Functioning Measures” is a validation studyof two relatively new instruments that were developed tocapture the impact of health on an individual’s ability toperform his/her role in the workplace. The OccupationalRole Questionnaire is a both a condition specific, rolespecific measure intended to assess the impact of backpain on paid work performance. The Work LimitationsQuestionnaire is a generic, role specific measure intendedto capture the impact of general health on work perform-ance. The primary objective of this study is to examine thepsychometric properties of each of these measures withina population of surgical lumbar disc patients. Other objec-tives are to compare changes in these measures againstchanges in traditional return-to-work measures, and todetermine how well these different occupational role func-tioning measures correlate with changes in other genericand condition-specific quality of life [email protected]

van der Velde NewThe project “Non-surgical treatments for neck-shoul-der pain in working populations” is a systematic litera-ture review conducted within the framework of theCochrane Collaboration Back Review Group. It will iden-tify and summarize the available evidence on the effec-tiveness of various non-surgical treatments for neck-



shoulder pain in working populations, including activeexercise, drugs, and manual therapies.Co-investigators: van Tulder M, Côté P, Aker P, Hogg-Johnson [email protected]

van der Velde NewThe project “Utilities for health states associated withneck pain and common non-surgical treatments” willdirectly measure health state preferences (utilities) fromsamples patients in Los Angeles and Toronto presenting tophysicians, physical therapists and chiropractors for whip-lash / non-specific neck pain. A utility is a quantitativemeasure of the strength of an individual’s preference for atreatment outcome expressed on a scale from 0–1. Utilitiesare required in the economic evaluation of health treat-ments and decision analytic models.Co-investigators: Krahn M, Maetzel A, Hurwitz E, Hogg-Johnson S, Llewellyn-Thomas H, Naglie [email protected]

van der Velde NewThe project “Decision analysis of non-surgical treat-ments for non-specific neck pain and acute whiplash”will provide a comprehensive overview of the benefits andrisks of neck pain treatments that incorporates patient-based preferences for outcomes to treatment. The primaryaim of this analysis is to assist clinical decision making andpolicy decisions by synthesizing the existing evidence in adecision analytic model that includes the relevant out-comes associated with each treatment.Co-investigators: Krahn M, Maetzel A, Hogg-Johnson S,Hurwitz E, Llewellyn-Thomas H, Cassidy [email protected]

van der Velde NewThe project “Neck pain patients’ preferences for com-mon non-surgical treatments” will quantify the strengthof preference for specific treatment alternatives amongneck pain sufferers using the probability trade-off tech-nique. Patients are presented with descriptive andprobabilistic information about the treatment protocols,and potential benefits and risks associated with 3–4 treat-ment alternatives. The probabilistic information (i.e. prob-ability of benefit, risk, side effects) is changed incremen-tally until the patient switches to another treatment. This

‘switch point’ indicates the patients’ strength of preferencefor a specific intervention. This technique assessed indi-viduals’ strength of preferences for, for example, treat-ment A relative to treatment B within the confines of aparticular clinical context.Co-investigators: Llewellyn-Thomas H, Hurwitz E,Maetzel A, Krahn [email protected]

van der Velde NewThe project “Measuring change in neck-pain relateddisability in acute whiplash patients responding totreatment: does the Neck Disability Index possess theappropriate measurement properties?” will evaluatethe NDI’s measurement properties and determine whetherit can appropriately be used to evaluate change in neck-pain related disability in patients responding to treatment.A systematic literature review will be conducted to iden-tify studies which have investigated the NDI’s measure-ment properties. The NDI will then be critically appraisedon its reliability, validity (content, construct, criterion,face), responsiveness, interpretability and [email protected]

Vernon Jansz McDermaid Goldsmith“Randomized clinical trial comparing chiropractic andmedical treatments for tension headache”[email protected]

As our chiropractic research culture grows and flour-ishes, so too does the quantity and quality of chiropracticresearch – all to the benefit of our patients and Canadiansat large.

We now need to integrate our new chiropractic knowl-edge into the health care system. Our chiropractic evi-dence is becoming more important and critical to effectivehealth policy development and health planning.


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CONSORTIAL NETWORK PROJECTS

Project titleQuantification of Mechanical Low Back Pain.

Consortial membersDr. Greg Kawchuk DC, PhDUniversity of CalgaryDr. Jim Dickey PhDUniversity of Guelph

DescriptionMechanical low back pain (mLBP) is a clinical diagnosismade when spinal pain is produced by benign mechanicalstimuli in the absence of an identifiable etiology. Despitethe frequency of this diagnosis, identification of the tissuesand mechanics associated with mLBP have remained elu-sive due to problematic investigative techniques. Theseinclude the inability to quantify tissue mechanics directly,restriction from use in large populations, unreliable tissueloading conditions and failure to quantify pain responsesduring the mechanical test itself. Given that most studieshave utilized one of these problematic techniques, it isunlikely that the following research question has beenanswered accurately: is ‘mechanical’ back pain truly me-chanical in nature. Therefore, the primary goal of thisstudy is to determine if the mechanical behaviours ofspecific spinal tissues are related to pain intensity and ifthis relation changes over the clinical history of mLBP. Toachieve this goal, a non-invasive technique (ultrasonicindentation, UI) will be used to quantify the mechanicalresponses of lumbar vertebra and their overlaying softtissues during controlled indentation loads. Specifically,UI will be modified for clinical use and performed pro-spectively in the treatment sessions of a mLBP out-patientpopulation (n = 170). During UI, changes in pain intensitywill be recorded continuously by a patient-held plungerand correlated to continual measures of vertebral displace-ment, soft tissue compression and spinal stiffness. It isexpected that clinically significant correlations of pain andtissue mechanics will exist and these correlations willchange with the resolution of the complaint. This studywill be the first to examine a large population of mLBPpatients using direct measures of tissue mechanics and willprovide long over due data regarding the validity of mLBPas a diagnosis.

Funding2002–2004 Ontario Chiropractic Association, Ministry ofHealth of Long Term Care.Kawchuk – Principal InvestigatorDickey – Co-investigatorOperating Funds $31,400 Total

Project Title:The Bone and Joint Decade 2000 B 2010Task Force On Neck Pain & ItsAssociated Disorders

Consortial membersDr. David Cassidy DC, PhDUniversity of AlbertaDr. Pierre Côté DC, PhDUniversity of Toronto

IntroductionNeck pain is a common source of pain and disability in theindustrialized world. Although several treatments areavailable for the treatment of neck pain, there is a lack ofconsensus about the relative effectiveness of most inter-ventions. This project, started in 2000, includes a suite ofstudies, designed to answer different research questions.

Project StatusLiterature review underway; other studies under develop-ment and will start in 2003.

ObjectivesTo conduct a systematic literature review on the epidemi-ology, diagnosis, treatment (benefit and harm) and prog-nosis of neck pain.To determine the risks of stroke associated with manipula-tion and the risks of gastrointestinal events associated withnon-steroidal anti-inflammatory medication.To conduct a decision analysis study of patient preferencewith regard to the most common treatment for neck pain.To develop clinical guidelines for the treatment of neckpain.

Potential Audiences and SignificanceThe Task Force will synthesize and produce new knowl-edge that will be relevant to patients, clinicians, research-ers, insurers and policy makers. The guidelines will inform



all stakeholders about the best current practice for thetreatment of neck pain and the research community aboutresearch priority.

Stakeholder Involvement in Project DevelopmentClinicians (physicians, chiropractors, physiotherapists,psychologists), Researchers (epidemiologists, clinical epi-demiologists, biostatisticians)

ResearchersJ.D. Cassidy (Alberta Centre for Injury Control and Re-search, Department of Public Health Sciences, Universityof Alberta), Pierre Côté (Institute for Work & Health),Sheilah Hogg-Johnson (Institute for Work & Health),Claire Bombardier (Institute for Work & Health), DorcasBeaton (Institute for Work & Health), Gabrielle van derVelde (Institute for Work & Health), L. Carroll (AlbertaCentre for Injury Control and Research, Department ofPublic Health Sciences, University of Alberta), S.Haldeman (President, Scientific Secretariat), E. Hurwitz(University of California, Los Angeles), P. Peloso (Uni-versity of Iowa), Å. Nygren (Karolinska Institute).

Total Project Funding$2,800,000 NCMIC, CCPA and other sources

Project TitleIs The Choice of Care Provider Associated With HealthOutcomes After Whiplash?: A Study of Whiplash in aCohort of Traffic Injury Claimants in Saskatchewan

Consortial membersDr. Pierre Côté DC, PhDUniversity of TorontoDr. David Cassidy DC, PhDUniversity of Alberta

IntroductionWhiplash is a common source of pain and disability thatplaces an increasing burden on Canadian society and thehealth care system. Patients suffering from whiplash re-ceive a variety of treatments from various health careproviders; however, we do not know which configurationof care providers promotes early recovery.

ObjectiveTo update the systematic review published by the QuebecTask Force on Whiplash-Associated-Disorders, and topropose a conceptual framework to conduct systematicreviews on the prognosis of whiplash.To determine if neck pain intensity, physical functioningand depressive symptoms are associated with time-to-claim-closure after whiplash and to determine if thestrength of association varies with insurance systems.To determine whether a specific configuration of healthcare practitioners available to patients with acute whiplash(mainly medical doctor, mainly chiropractor or combinedcare) is associated with shorter time-to-claim closure.

MethodsA historical population-based cohort design has been se-lected. The data will be obtained by linking data from threesources: 1) the Population-based Inception Cohort Studyof Traffic Injury in Saskatchewan; 2) the SaskatchewanGovernment Insurance Company (SGI) claimant data-base; and 3) Saskatchewan Health Care Utilizationdatabases.

Potential Audiences and SignificanceThis study will provide high quality evidence regardingthe most appropriate type of care for patients with whip-lash injuries. For insurers and workers’ compensationboards, the findings will guide policy decisions regardingthe allocation of the most appropriate care for individualswith neck injuries. The results will clinically inform clini-cians with a useful guideline to map the expected out-comes and time to recovery for various treatments. Gov-ernments will have a description of the health-careutilization for one of the most costly compensated injuriesin Canada.

ResearchersPierre Côté (Institute Coordinator, PhD thesis), ClaireBombardier, JD Cassidy (Alberta Centre for Injury Con-trol and Research, Department of Public Health Sciences,University of Alberta) L Carroll (Alberta Centre for InjuryControl and Research, Department of Public Health Sci-ences, University of Alberta), John Frank (University ofToronto, Institute for Work & Health, University of Cali-fornia, Berkeley), Sheilah Hogg-Johnson


C Martin

External FundingHealth Canada, through National Health Research andDevelopment Program (NHRDP) PhD fellowship toPierre Côté; $72,000; 1997–2001.Health Canada, through NHRDP grant, $107,270; 1998–2001.

JOURNAL OF THE CANADIANCHIROPRACTIC ASSOCIATION

The JCCA is delighted to announce that five new membershave joined the Editorial Board:

Dr. Claire Johnson DC, MSEd, DACBSP from PalmerCollege of Chiropractic West and University of SouthernCalifornia,

Dr. Bart Green DC, MSEd, DACBSP from Palmer Col-lege of Chiropractic West and University of SouthernCalifornia,

Dr. Brian Gleberzon DC from CMCC

Dr. Paul Bishop DC, MD, PhD from the University ofBritish Columbia and Vancouver General Hospital, and

Dr. Jill Hayden DC from the University of Toronto.

Congratulations are also extended to Dr. Pierre CôtéDC, PhD from the University of Toronto who has becomean Assistant Editor at the JCCA.

The JCCA gratefully acknowledges the following doc-tors who have served in the capacity of Editorial Boardmember and completed their terms, and thanks them fortheir service to the scholarly literature: Dr. Wilbur Kelsick,Dr. Hartley Bressler, Dr. Kim Humphreys,Dr. Toffy Kobrossi, and Dr. Stephen Burns.

FUNDED GRADUATE POSITIONS AVAILABLEIf you are a chiropractor and interested in pursuing gradu-ate studies in a masters or PhD program, please contact Dr.Greg Kawchuk at the University of [email protected]

ALBERTA PROVINCIAL CIHR TRAININGPROGRAM IN BONE AND JOINT HEALTHThis is a CIHR funded specialized program between theUniversity of Alberta and the University of Calgary. It is aunique opportunity for training and research as a clinician/scientist in bone and joint health. Chiropractors who arePhD students are eligible and Dr. David Cassidy is amentor for the Bone & Joint Program in Alberta. If you areinterested contact him (below) for further information.Here is the link to their site.http://www.boneandjoint-training.ca/index.html

J. David Cassidy, DC, PhDAssociate Professor of Public Health (Epidemiology) andMedicine (Rheumatology)Health Scholar, Heritage Foundation for MedicalResearch

Alberta Centre for Injury Control and ResearchDepartment of Public Health SciencesUniversity of Alberta3080 RTF, 8308 – 114 StreetEdmonton, AlbertaCanada T6G 2E1

Phone: (780) 492-0925;Fax (780) [email protected]

UPCOMING CONFERENCE/EVENTS• November 21–22

3rd Biennial Canadian CochraneSymposium on the theme ofKnowledge Translation in Hamilton,Ontario. Check out their website atwww.cochrane.org

SUMMARYAs Committee Chair, I would like to acknowledge thededication that both The CCA and the Canadian Chiro-practic Research Foundation have made first to Canadians,and also very importantly to chiropractic research, and toour chiropractic researchers. Both of these organizationshave undertaken very serious roles in the development ofCanada’s outstanding world class chiropractic research-ers. They have raised the profile of chiropractic to new



Hosted by the Consortium of Canadian Chiropractic Research Centres

University of Alberta, University of British Columbia, University of Calgary, Université du Québec à Trois-Rivières (UQTR), Université du Québec à Montréal (UQAM), Institute for Work and Health (Toronto),Canadian Memorial Chiropractic College (CMCC), University of Toronto, University of Guelph, LavalUniversité and the College of Chiropractic Sciences.

Date: TBAPlace: TBA

Symposium convenor: Dr. Jean Boucher PhD

CALL FOR ABSTRACTS WILL BE SENT OUT IN THE COMING MONTHS

Contact: Dr. Jean Boucher PhD or Dr. Allan Gotlib DCEmail:

Sponsored by The Canadian Chiropractic Association

heights in Canada and fostered growing positive relation-ships with both the government and the public.

The CCA mission of improving the health and quality oflife for Canadians through chiropractic research will suc-cessfully lead to The CCA’s vision of every Canadianenjoying the benefits of full and equitable access to chiro-practic care.

To date, The CCA has been very successful in fosteringa chiropractic research culture in Canada, in developing acredible Research Agenda, in disseminating chiropracticresearch, in facilitating university-based Chiropractic Re-search Chairs across Canada, and in building strong rela-tionships with CIHR.

A national community of fulltime research scholars inchiropractic will ensure that Canadians will come to re-ceive the benefits that chiropractic care brings. In order forchiropractic to become fully integrated into our nationalhealth care system our discipline must first be entrenchedwithin the university system and we are making greatstrides. Continuing to build intellectual capacity, estab-lishing university-based research chairs, integrating ourchiropractic knowledge, providing for fulltime chiro-practic research careers – these are the keys to our contin-ued success.

The Board of Governors of The CCA are to be congratu-lated for their exemplary commitment. For further infor-mation contact Dr. Allan Gotlib, CCA Director, ResearchPrograms at tel: 416-781-5656, fax: 416-781-0923, email:[email protected]

This Bulletin is distributed to the Canadian chiroprac-tic research community. (30/05/03) You may view thepreceding seven bulletins on the CCA website atwww.ccachiro.org

HELPSUPPORT

CHIROPRACTIC RESEARCH

BECOME A MEMBER OF THECANADIAN CHIROPRACTICRESEARCH FOUNDATION

Contact Dr. Allan Gotlib DCAssistant Secretary CCRF

Tel: 416-781-5656Fax: 416-781-0923

Email: [email protected]

4th Canadian Chiropractic Scientific Symposium

C Martin Canadian Chiropractic Research Bulletin #8 · chiropractic care: Cochrane systematic...

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