This paper focuses on the methods of a single study, incorporating data from chiropractic clinics into an evidenced-based investigation of the appropriateness of manipulation for chronic back pain.,A cluster sample of clinics (125) from 6 sites across the United States was chosen for this observation study. Patients with chronic low-back and neck pain were recruited using iPads, completed a series of online questionnaires, and gave permission for their patient records to be scanned. Patient records for a random sample were also obtained. The RAND staff and clinic personnel collected record data.,We obtained survey data from 2024 patients with chronic low back pain, chronic neck pain, or both. We obtained patient record data from 114 of 125 clinics. These included the records of 1475 of the individuals who had completed surveys (prospective sample), and a random sample of 2128 patients. Across 114 clinics, 22% of clinics had patient records that were fully electronic, 32% had paper files, and 46% used a combination. Of the 114 clinics, about 47% scanned the records themselves with training from RAND. We obtained a total of 3603 scanned records. The patient survey data were collected from June 2016 to February 2017, the provider surveys from June 2016 to March 2017, and the chart pull from April 2017 to December 2017.,Clinics can be successfully recruited for practice-based studies, and patients can be recruited using iPads. Obtaining patient records presents considerable challenges, and clinics varied in whether they had electronic files, non electronic records, or a mixture. Clinic staff can be trained to select and scan samples of charts to comply with randomization and data protection protocols in transferring records for research purposes.

BACKGROUND: Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone. METHODS/DESIGN: This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation. DISCUSSION: Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability.

In this article the authors examine an exemplar (dietary supplements) of the clash between science and law and the dangers inherent in judges wandering in the murky field of scientific controversy and using it as the basis of a judgment.

Whenever a new field emerges in health care, a period is experienced in which the field tries to define itself. This is the position evidence-based dental practice finds itself in at the moment. In this paper, it is argues that, for dentistry to enter into the brave new world of evidence-based practice, it will require some rethinking of the research enterprise in the profession.

Role in Health Care, Stroup et al. define an observational study as "an etiologic or effectiveness study using data from an existing database, a cross-sectional study, a case series, a case-control design, a design with historical controls, or a cohort design." Generally, there are several major problems with the use of observational studies in systematic reviews of evidence for a treatment procedure. The first is that since all observational studies lack randomization, true assessment of efficacy is not possible. Furthermore, it is not possible to determine what biases may have influenced the results, both from the provider and the patient. Analytically, results from observational studies either cannot be pooled for a meta-analyses or can be done so only with caution.

Barriers have been identified in the literature to the implementation of evidence-based practice in dentistry. A major concern is the lack of rigorous evidence for clinical practices. Little attention has been given to the lack of rigorous health services research. Evidence-based practice is more about effectiveness than efficacy and will influence the type of research that characterizes health services research (HSR) because it involves levels of data below that of the random controlled trials, involves questions about the appropriateness of care, and involves examining the structure, process, and outcomes of care. The need for HSR can be seen by examining the appropriateness of dental care and health-related quality of life outcomes. The conclusion to be drawn is that evidence-based dentistry needs HSR if it is to fulfill the promise currently held for it in the profession.