Practice-Based Research (PBR) Practice-Based Research is a method of doing clinical research that collects data from practitioners in the field. While the research design is not controlled and can’t usually answer questions about the mechanisms of health care, it is about the best way of showing what happens in real world practices. The key is to collect data across a wide number of practice locations, looking at the practitioners’ methods and the changes in health of patients as they undertake a course of care.

A Practice-Based Research Network (PBRN) Practice Based Research Network is the group of practitioners and their patients that are devoted to supplying information to a PBR study.

ResarchLink PBRN is the PBRN being created by Life University’s Office of Sponsored Research and Scholarly Activity under the direction of Dr. Stephanie Sullivan. This PBRN is being developed to answer specific research questions relative to the care and benefits provided to chiropractic patients on a daily basis. Further, this research is being done from a contemporary vitalism perspective, which seeks to explore and understand the underlying elements being impacted in the individual patient.

A MINI-REVIEW OF CHIROPRACTCIC PBR

Healthcare research is beginning to trend towards a model that takes into account the entire patient encounter. While Randomized Controlled Clinical Trials (RCTs) remain the gold standard to assess clinical outcomes, there are many critics that feel this research does not evaluate the true clinical effects. The sterile environment may taint and narrow the clinical encounter that, in a holistic practice environment, has historically led to positive patient outcomes. Practice-based research (PBR) allows for the generation of healthcare data on a large-scale collaborative basis while maintaining the integrity of a traditional clinical environment.

Chiropractors see amazing results in their patients on a daily basis; however, if time and care are not taken to track the information in a valid format; present the information to peers; and publish the information for the general public, then the global impact of these stories remains limited. Planned research and implementation of research tools provides the potential fuel for Chiropractic to become a global leader in the healthcare system. While some PBR does exist in the chiropractic field, there has yet to be an adaptable instrument with a strong committed group of doctors implemented that consistently supplies data that answers relevant research questions key to the advancement of the profession and care of the patient.

There have already been a number of attempts by researchers in the chiropractic field to employ practice-based research networks to answer many of these questions. Some of the earliest work was done by Cheryl Hawk while at Palmer College. She used the SF-36 to look at patient characteristics in a number of practices and published those findings in a variety of places.[1-3] Hoiriis and Owens did very similar work at Life University in the early 1990s, focusing on Upper Cervical practitioners. Several articles were published in the Chiropractic Research Journal (CRJ) that showed significant increases in health scores on the SF-36 survey, changes in x-ray listings and improvements in general health impression.[4-6] They also showed how challenging it is to follow groups of patients over a whole course of care. Their follow-up rate was only about 50%. Some prominent researchers from the RAND Corporation also followed this model of practice-based research, looking at the characteristics of chiropractic patients across a wide range of practices.[7]

Rupert used PBR methods to explore questions about the use of maintenance care in Chiropractic, [8-10] and Alcantara has done several studies looking at chiropractic care for children.[11-12] Nyeindo and Haas probably did the best practice-based study of low back pain, comparing chiropractic care to medical care. They managed to incorporate a four year follow-up.[13-16]

The studies above were all carried out using surveys that patients and doctors filled out on paper or electronically. More recently, governments, insurance companies and HMOs have been looking at their claims data to evaluate the cost-effectiveness of chiropractic care compared to other types of care.[17-19] They have also realized that access to patient data in their databases could open the doors to studying a wider range of questions besides the financial one.

Life University seeks to develop a dynamic, progressive practice based research network (PBRN) that will advance the mission and core proficiencies of the University through LIFE-focused research questions and engaging the chiropractic and human performance community in the research process. This project will include the development of a platform and protocols for the collection of valid and reliable information, recruitment and training of chiropractors in the field, as well as development and implementation of studies designed to answer high-level specific research questions relevant to the current needs of the profession, including cost-effectiveness.