Field Doctor Research

Field doctors' experience is vital to chiropractic research. The findings in one chiropractic field doctor's office that is published often finds itself in good company in a researcher's hands. Researchers look for trends. Field doctor reports are documentation of trends. Researchers can gather similar reports and establish a study based on the findings.
Bottomline: Field doctors are key to research!
The First Field Doctor Research Collection
In the mid-1980's Dr. Cox noticed the increase insurance and Medicare and their establishing number of visits for patient treatment. He gathered 30+ colleagues together to start the collection of field doctor experience:
  • number of visits to get a patient to maximum improvement
  • number of days to get a patient to maximum improvement
  • patient response to care.
He partnered with the statisticians from the local university, Indiana-Purdue University Fort Wayne, to help set up the 293 variable data collection and examination forms and analyze the results. It was an exciting time! From this humble beginning, 1000 patient cases' data was collected. The results were separated about by condition as well as by spinal segment level. Results were published:
  • Cox JM, Shreiner S:  Chiropractic manipulation in low back pain and sciatica:  statistical data on the diagnosis, treatment, and response of 576 consecutive cases.  Journal of Manipulative and Physiological Therapeutics 7(1): 1-11 (March 1984)
A chiropractic multi-center observational pilot study to compile statistics on the examination procedures, diagnosis, types of treatment rendered, results of treatment, number of day of care, and number of treatment required to arrive at a 50% and a maximum clinical improvement was collected on 576 patients with low back and/or leg pain. The purpose was to determine the congenital and developmental changes in patients with low back and/or leg pain, the combinations of such anomalies, the accuracy of orthodox diagnostic tests in assessing low back pain, ergonomic factors affecting onset, and, ultimately, the specific difficulty factors encountered in treating the various conditions seen in the average chiropractor's office. For all conditions treated,

        - the average number of days to attain maximum improvement was 43.
        - the average number of visits  to attain maximum improvement was 19.
It was concluded that this study provided useful data for assessment of routine chiropractic office based diagnosis and treatment of related conditions; however, further controlled studies are necessary for validation of specific parameters.
  • Cox JM, Feller, J: Chiropractic treatment of low back pain: a multi-center descriptive analysis of presentation and outcome in 424 consecutive cases. Journal of Neuromusculoskeletal Systems 1994; 2(4):178-190
Demographic, clinical and radiographic findings were collected for 424 consecutive low back and/or leg pain patients receiving chiropractic treatment at seven participating centers. A standardized, 293-variable history and examination form was collected for each patient and they were classified into one or more of 15 clinical categories. Outcome measures included the response by days and treatments to attain maximum relief. For the entire patient populations, the average number of days to maximal improvement was 27, with a mean of 11 treatments having been administered over this time. Eight percent of this group of patients reported good to excellent relief of pain.
Among individual categories, patients with an L5 transitional segment had the best response (95% good to excellent outcome), while L4-L5 nuclear prolapse/free fragment patients had the worst response rates (57% good to excellent).
Patients with nuclear protrusion required a longer treatment period and more visits than those with spondylolisthesis, facet syndrome, or spondyloarthrosis.
These results are discussed in terms of other reports of non-surgical care as well as the natural history of low back pain. These data may be expected to aid in the design of future randomized controlled studies into the efficacy of chiropractic manipulation. 

An overview of Cox® distraction manipulation protocols is presented including diagnosis and treatment decision making in low back pain and sciatica cases and proper utilization of flexion distraction in treating lumbar spine and lower extremity pain. In addition, the outcome of 1,000 cases involving low back and/or leg pain treated with chiropractic adjusting (92% utilizing flexion distraction) is presented.
A qualitative clinical and literature review provides the basis of the overview of diagnostic and treatment protocols. A descriptive case series design was used to collect outcome information on 1,000 patients with low back and/or leg pain; patients were pooled from two separate studies. Patients were treated by 30 different chiropractors, and a minimum of 20 cases was supplied by each physician.
A descriptive review of cases showed:

    • Less than 4% of patients with low back or leg pain were candidates for surgery.
    • Less than 9% of patients reached the chronic stage of care.
    • The mean number of days to maximum improvement under care was 29.
    • The mean number of treatments to maximum improvement was 12.

The results of this study provide some evidence for the use of chiropractic management, particularly flexion distraction manipulation, in the treatment of back pain problems due to a variety of mechanical causes.

Today's Field Doctor Research Opportunities
  • Cervical Spine Patient Cases - These were completed in early 2009, and analysis and writing are underway.
  • Lumbar Spine Patient Cases - This is to get underway in late 2010.
To participate in any of these, please click here for a description of the cervical spine / neck pain study paraments. The lumbar spine / low back pain study will be similar.

Today's Field Doctor Case Reports
  • Informal and more formal are published FREE monthly. (Link to Case Reports)
  • Case reports often are the basis for more more formal and potentially federally funded investigations.
  • Case reports are vital to the life of the technique.
  • Consider writing one yourself! (Link to Case Report Writing)