FCER Announces Funding of New Research Grants;
NCMIC Serves As Major Funding Source

The Board of Trustees for the Foundation for Chiropractic Education and Research (FCER) has approved the following research projects for funding:

"Lumbar Spine Segmental Flexion-Extension Induced During Chiropractic Manipulative Therapy." The principal investigators are Nelson Marquina, DC, Ph.D, and Scott Banks, DC, and the research will be conducted at Logan College of Chiropractic. The purpose of this research is to directly measure the degree of flexion-extension imposed on the lumbar spine during side posture rotary manipulation.

Despite numerous calculations that suggest that normal discs in rotation can withstand forces five to 10 times the amount of rotation that is actually allowed by posterior facet joints, there are authorities who maintain that lumbar segments are significantly flexed during manipulation, opening the facets and allowing sufficient segmental rotation to injure the disc under certain circumstances. Others argue that lumbar segments remain in lordosis or even extend slightly during manipulation, affording protection to the disc in rotation and rendering injury during this procedure highly unlikely.

To settle this debate and provide much-needed data that would most likely refute remaining arguments that side-posture manipulations cause disc herniations, the research team proposes to take direct measurements of the degree of flexion-extension at the segmental level encountered during side posture manipulation using two radiographs of the lumbar spine: 1) neutral lateral in the decubitus position, and 2) a lateral view at the "lock" position on a side-posture diversified adjustment. The study population consists of 40 males aged 21-30 who are asymptomatic, generally healthy, and without history of spinal trauma or pathology.

This study will be funded by NCMIC Insurance Company and managed by FCER.

"Comparison of Treatment Outcomes and Cost-Effectiveness Between Chiropractic and Back Surgery for the Treatment of Low Back Pain and Sciatica Secondary to Lumbar Herniated Disc." The research will be conducted in private practice and Foothills Hospital by D. Gordon McMorland, DC.

This pilot study seeks to assess the feasibility and methodology of a randomized controlled trial investigating whether chiropractic care for patients afflicted with low back pain and leg pain that is secondary to lumbar herniated disc will improve patient outcome and reduce treatment costs compared to back surgery.

Forty subjects who are candidates for surgery will be randomly assigned to chiropractic therapy (diversified technique, up to 20 manipulation treatments over a four- to six-week period) or spinal surgery (decompression) as directed by the attending neurosurgeon. Those individuals not responding to treatment (chiropractic or surgical) will be allowed to cross over after eight weeks.

Standardized rehabilitation exercises will be given to all patients in both arms of the study.

The primary outcomes to be followed are: 1) low back disability, 2) pain, 3) direct health-care costs, and 4) health-care utilization. Secondary outcomes to be tracked are: 1) days of work lost, 2) health-related quality of life, and 3) patient satisfaction. Methodological issues to be tested in this pilot study will include 1) patient retention, 2) outcome measures feasibility/reliability, and 3) statistical analyses.

With the increasing emphasis being made on the integration of complementary therapies in the health care system, it is important to identify the possible advantages to less invasive and potentially cheaper alternatives to surgery.

This study will be funded by NCMIC Insurance Company and managed by FCER.

"The Biochemical Profile of Myofascial Trigger Points: A Clinical Microdialysis Study." Conducted at New York Chiropractic College, the research team will be led by Veronica M. Sciotti, Ph.D. The purpose of the proposed study is to describe, for the first time, the extracellular milieu of muscle and connective tissues cells using a novel microdialysis sampling technique from the trapezius muscle of human subjects.

Clinically diagnosed myofascial trigger points (TrPs) are to be sampled, with unaffected muscle on the opposite side of the subject serving as a control. It is presumed that microdialysis provides an excellent model of microcirculation by means of its ability to selectively collect low-molecular weight metabolites after the insertion of the probe into the fiber of interest.

The clinical understanding to be gleaned from this study is twofold. First, the biochemical data obtained will further describe potential perturbations in muscle metabolism that may contribute to the clinical presentation of myofascial TrPs. Secondly, any changes observed may serve as future baselines with which to evaluate the effectiveness, if any, of chiropractic treatment in treating myofascial syndrome.

This study is to be funded by NCMIC Insurance Company and managed by FCER.

"A Multisite Trial: Chiropractic and Asthma with Physiological Markers," headed by Ray Hayek, Bsc (Hons), MChiro (Australia), at Macquarie University. The investigative team in this proposal wishes to conduct a 10-center multisite trial conducted over 18 months to assess the effects of chiropractic techniques (Activator, Gonstead, Diversified, and Sacral Occipital) on both the physiological and global symptoms of patients with asthma.

A total of 420 subjects, 315 of whom suffer from asthma, will be divided into four groups of 105 each and tracked according to a parallel study design. The asthmatics who are already under medical management will then be divided into three groups as follows: 1) receiving chiropractic treatment at the clinics; 2) receiving no chiropractic treatment but visiting the clinic the same number of times as the treated group for monitoring; and 3) receiving no chiropractic treatment and being monitored at the patient's home. The fourth non-asthmatic group would undergo a regimen identical to Group 3) above.

Two weeks would be allowed for a pretrial baseline period, followed by one of the four interventions indicated above for a six-week period, with chiropractic treatments administered three times per week. This in turn would be followed by six weeks of post-trial readings. The novel outcome measure in this trial is the assessment of stress by measurement of salivary cortisol and IgA against the internal standards of albumin, creatinine, and osmolality (rate of salivary production). Respiratory status will be determined by spirometry to measure lung function. Functional status outcome variables include DASS (Depression and Anxiety Stress Scale), SF-36 (general health status), VAS (Visual analogue scale), and a wellness inventory.

This research plan has been propelled by previous studies which suggest that 1) a statistically significant pattern of spinal dysfunction is observed in young asthmatics, 2) anxiety is associated with asthma, and 3) cortisol levels may decrease in asthmatics following spinal manipulation. All biochemical markers will be measured from salivary samples which are frozen after being taken from each subject at 8 am and 8 pm, the peak and nadir phases of the circadian rhythm in humans.

This study has been approved for funding by the FCER Board of Trustees.

The Foundation for Chiropractic Education and Research is dedicated to its mission of furthering research efforts for the chiropractic profession. Because the mission also includes the dissemination of research results to the profession, FCER will make every effort to distribute research results as they become available. NCMIC Insurance Company is the largest chiropractic malpractice insurance company, established in 1946 and providing coverage for more than 28,500 doctors of chiropractic. NCMIC is dedicated to advancing the chiropractic profession by providing funding for research, educational scholarships, and other services to enhance the success of the practitioner of chiropractic.

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