“If we want more evidence-based practice, we need more practice-based evidence.”1
Definition of Practice-Based Research Network (PBRN)
The U.S. Agency for Healthcare Research and Quality (AHRQ) defines a PBRN as a group of clinicians and practices working together in ambulatory care to answer community-based health care questions and translate research findings into practice.2
PBRNs address research questions that require a real-world setting to be answered. Ambulatory care settings, partnering with academic institutions, form the “laboratory” in which these research questions are pursued.
The Integrated Chiropractic Outcomes Network (ICON) is a new PBRN just initiating its first project. ICON is an interinstitutional collaboration combining the expertise of experienced investigators who have conducted a number of practice-based research studies in other venues. ICON is intended to be an “engine” that can drive projects that require a real-world ambulatory care setting in order to answer a specific research question. ICON’s mission is to conduct collaborative research through a partnership between researchers and practitioners with the ultimate goal of enhancing the health of the public and contributing to the scientific evidence base related to health promotion and disease prevention.
Chiropractic research, to date, has focused more on pain and symptom management than on prevention and health promotion, even though chiropractic has traditionally considered itself to be prevention-oriented.3 However, in a time when lifestyle factors have become the leading actual causes of death,4 research into the role of chiropractic in disease prevention and health promotion must become a priority. At this time, such evidence is scarce. Some studies have shown that wellness care accounts for a significant proportion of chiropractic patient visits,5-7 and others suggest that patients receiving chiropractic care appear to be healthier than patients who do not;6, 8 however, a cause-and-effect relationship between wellness care and improved long-term health outcomes has yet to be clearly demonstrated.
The Importance of Observational Studies in Health and Wellness Research
Practice-based research study designs are usually observational. Observational studies make important contributions to the scientific evidence base. They are particularly suited to investigating complex clinical interactions such as those involved in providing patients with health promotion counseling. A prospective analytic study, an observational design which examines relationships among a number of variables, can be used to investigate a complex, real-life intervention designed to prevent illness and improve health among ordinary patients. This type of study can evaluate risk factors for negative health outcomes, which is consistent with a model of health rather than disease. It enables investigators to gather information on factors which precede, and may contribute to, either improved or impaired health. Because it is prospective, this is a very strong design for establishing that the variables of interest did, in fact, precede the outcome of interest. Since existing evidence related to chiropractic wellness care has not been able to determine whether healthier patients seek chiropractic care or chiropractic care makes patients healthier, this issue is essential.
The Role of Practice-Based Research
One important reason for the underutilization of prospective observational designs in chiropractic research is the high cost and logistical complexity of assembling and following an appropriate cohort. ICON’s first study is intended to begin to lay the groundwork for such a future study. PBRNs have been used in other health professions as well as chiropractic for many years to investigate ways to improve clinical practice, including the delivery of health promotion and prevention services.9-13
A Call for Participation in ICON
ICON’s first project is a cross-sectional study to gather preliminary information about chiropractors’ use of health promotion and prevention services. It will also collect demographics and practice characteristics on the participating doctors, as well as patients’ chief complaints and other characteristics, in order to get a “snapshot” of the participating practices.
We will collect data for a one-week interval in which all patients in the participating practices will complete a very brief, one-page form. Doctors will complete a more detailed set of forms about their practices. Samples of these forms may be accessed on this site and are designed to be completed and returned electronically.
There are, of course, no costs to doctors or patients for participating in this study. The study has been approved by the Institutional Review Boards of the collaborating institutions. All participating doctors will receive a report of the study’s findings, and will be acknowledged in any resulting publications.
PBRNs are designed to minimize intrusion into the participating practices. We hope this study will serve to introduce interested doctors to practice-based research. The investigators and the practitioners will form a partnership to “put research into practice.”
For more information on how to participate, please visit the ICON forum here or click on the “Forums” link within the navigation bar at ChiroACCESS.
ICON investigative team
- Cheryl Hawk, DC, PhD, CHES, program director—Logan College of Chiropractic
- Ronald Rupert, DC, MS, investigator—Parker College of Chiropractic
- Will Evans, DC, PhD, CHES, investigator—Texas Chiropractic College
- Harrison Ndetan, MSc, MPH, DrPH, biostatistician—Parker College of Chiropractic
- Michelle Anderson, program coordinator—Logan College of Chiropractic
Green LW. From research to "best practices" in other settings and populations. Am J Health Behav. May-Jun 2001;25(3):165-178.
Agency for Healthcare Research and Quality.
[ Full-Text Link ]
Evans MW, Jr., Rupert R. The Council on Chiropractic Education's new wellness standard: a call to action for the chiropractic profession. Chiropr Osteopat 2006;14:23.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291(10):1238-1245.
Rupert R. A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I. J Manipulative Physiol Ther 2000;23(1):1-9.
Rupert RL, Manello D, Sandefur R. Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II. J Manipulative Physiol Ther 2000;23(1):10-19.
Hawk C, Long CR, Boulanger KT, Morschhauser E, Fuhr AW. Chiropractic care for patients aged 55 years and older: report from a practice-based research program. J Am Geriatr Soc 2000;48(5):534-545.
Coulter ID, Hurwitz EL, Aronow HU, Cassata DM, Beck JC. Chiropractic patients in a comprehensive home-based geriatric assessment, follow-up and health promotion program. Top Clin Chiropr. 1996;3(2):46-55.
Cifuentes M, Fernald DH, Green LA, et al. Prescription for health: changing primary care practice to foster healthy behaviors. Ann Fam Med 2005;3 Suppl 2:S4-11.
Cohen DJ, Tallia AF, Crabtree BF, Young DM. Implementing health behavior change in primary care: lessons from prescription for health. Ann Fam Med 2005;3 Suppl 2:S12-19.
Crabtree BF, Miller WL, Tallia AF, et al. Delivery of clinical preventive services in family medicine offices. Ann Fam Med 2005;3(5):430-435.
Hawk C, Long CR, Perillo M, Boulanger KT. A survey of US chiropractors on clinical preventive services. J Manipulative Physiol Ther 2004;27(5):287-298.
Quintela J, Main DS, Pace WD, Staton EW, Black K. LEAP--a brief intervention to improve activity and diet: a report from CaReNet and HPRN. Ann Fam Med 2005;3 Suppl 2:S52-54.