Medicine, osteopathy, physical therapy and chiropractic colleges collaborate to study safety in spinal manipulation

A recent team grant by the Canadian Institute for Health Research is providing an innovative approach to researching patient safety for those who provide and receive spinal-manipulative therapy. The $2-million grant over five years brings together health researchers from across Canada and will involve input from four regulatory colleges in Alberta.

"From everything we understand about patient safety, the best way to achieve it is through a multidisciplinary approach-this involves four different professions all of whom have one area that overlaps," said Sunita Vohra, professor in the Faculty of Medicine & Dentistry and Alberta Heritage Foundation for Medical Research scholar. "Approximately half our population in Canada has received the therapy.

"To the best of our knowledge, this is the first time that the four colleges have collaborated with each other in a research initiative. We're thrilled to work with the colleges of medicine, osteopathy, physical therapy and chiropractic."

Vohra is joined on the Canada-wide team by fellow University Alberta researchers Greg Kawchuk, professor in the Faculty of Rehabilitation Medicine and Canada Research Chair in Spinal Function, and Timothy Caulfield, professor in the Faculty of Law and School of Public Health, as well as Heather Boon from the Leslie Dan Faculty of Pharmacy at University of Toronto and Maeve O'Beirne from the Faculty of Medicine at the University of Calgary.

Spinal manipulation, which is a non-invasive manual procedure applied to specific body tissues with therapeutic intent, is the most common complementary and alternative medicine procedure provided in North America. While manipulation is most commonly provided by chiropractors, it is also provided by physiotherapists, physicians and osteopaths.

At present, there is no formal reporting mechanism to document adverse events associated with manipulation. The study team aims to create a culture of safety around manipulation by developing instruments that practitioners and patients can use to record and report adverse events.

Caulfield, research director at the Health Law Institute, AHFMR senior scholar and Canada Research Chair in Health Law and Policy, will be exploring, as part of the study, the legal obligations of health-care providers, including the obligation to disclose the risks and limitations of the therapy.

"We are going to analyze the legal obligations associated with adverse events as well as explore how this therapy is depicted in the popular press," said Caulfield. "The public gets much of its information from the news, so we want to figure out what the news says about risks, limitations and adverse events."

Kawchuk will be looking at understanding how tissues might be injured from spinal manipulation and how that possibility can be reduced. With this information, he says he hopes to "design different ways to deliver spinal manipulation and create specific training simulators to help clinicians better deliver spinal manipulation."

This team approach is a novel tactic that is generating unique opportunities for the team members to interact and produce new ideas almost immediately.

All five researchers met at the U of A on May 19 with participants from the regulatory colleges as well as health-care providers, students and policy makers to begin a dialogue around fine tuning the grant and its implementation.

"It's a way to engage with people most directly involved from the very beginning," said Vohra. "The area we are studying, spinal manipulation, is something we all have in common in our regulated scope of practice. We're not taking a narrow look at this issue."