CCRF invests in evidence-based research to cost-effectively improve health outcomes for the over 11 million Canadians living with musculoskeletal pain and disability.
Thanks to the generosity of our funders and our league of clinicians and private supporters, CCRF is proud to have invested over $1,500,000 in these research projects:
Title: Neurophysiological mechanisms underlying pain relief by spinal manipulative therapy in patients with chronic primary low back pain
Lead: Dr. Mathieu Piché, Université du Québec à Trois-Rivières (UQTR)
Impact: This project will provide groundbreaking data on the neurophysiological mechanisms of pain relief by spinal manipulative therapy (SMT). Identifying the physical and psychological factors of SMT that contribute to the relief of chronic primary lower back pain can position chiropractic as high-value care for this widespread debilitating issue.
Title: An IDEAL-Rehab Framework to guide study design and conduct of rehabilitation interventions
Leads: Dr. Heather Shearer/Dr. Pierre Coté, Canadian Memorial Chiropractic College
Impact: Chiropractors are ideally positioned to provide clinical/rehabilitative care to minimize pain and its chronicity, as well as improve function and health using these interventions. This project will adapt the IDEAL Framework – which assesses the effectiveness of rehabilitation interventions – into a publicly accessible IDEAL-Rehab Framework for researchers, clinicians and policy-makers to facilitate evidence-based rehabilitation delivered by chiropractors and other Canadian providers.
Title: A community-based knowledge translation project to move current pain theory to practice
Leads: Dr. Peter Stilwell/Dr. Sabrina Coninx, McGill University, University of Southern Denmark, and the Vrije Universiteit Amsterdam.
Impact: This multi-site collaboration builds on previously funded studies and will produce a high-impact paper and resources (e.g., information sheet, infographic, educational video) for MSK-based clinicians, including chiropractors, on the enactive approach to pain. To do this, the team will define and describe key ideas and concepts so they are clear and clinically accessible. They will also create a robust research agenda for future theoretical and empirical research.
Title: Untangling the association between burden of chronic back pain problems, current utilization of chiropractic care, and availability of chiropractors at the health region level: ecological study
Leads: Dr. Dan Wang/Dr. Pierre Côté, Canadian Memorial Chiropractic College
Impact: This study will inform chiropractic policy-makers, government and payers about the role chiropractors can play in Canadian healthcare systems. Designed in collaboration with CCA and provincial associations and using high-quality regional data sets, this project will determine and map the prevalence of chronic back pain, chiropractic utilization and chiropractic availability across the country.
Title: Symptom change, including adverse events following chiropractic care during pregnancy: a feasibility study
Leads: Dr. Carol Ann Weis/Dr. Katherine Pohlman, Canadian Memorial Chiropractic College
Impact: While many pregnant women seek chiropractic treatment, they are underrepresented in research. This observational cohort study aims to describe 1) the conditions with which pregnant patients present to chiropractic offices; 2) the type of treatments used in real time to treat the pregnant population; 3) the change in symptoms experienced by these patients after a chiropractic visit; and 4) the frequency and severity of worsening/new symptoms following a chiropractic treatment.
Title: Do methodological trade-offs used to conduct rapid reviews of the literature lead to biased results and conclusions compared to systematic reviews?
Leads: Dr. Melissa Macmillan/Dr. Pierre Côté, University of Ontario Institute Of Technology
Impact: The use of rapid reviews within an evidence-informed policy framework places the chiropractic profession as leaders and can improve the practice of chiropractic and the safety of patients. This project is the first to investigate methodological trade-offs of rapid reviews related to rehabilitation and lead to a greater understanding of the evidence synthesises generated by them and their use by health policy decisionmakers with the aim of helping to improve MSK health by clinicians and organizations, including chiropractic associations and Colleges.
Title: Fast Stretch Shorten Cycle Regulation in ACL Injured and Non‐Injured Athletes
Leads: Nathan Boon‐van Mossel / University of Calgary
Impact: This project’s purpose is to develop a new test to evaluate recovery from anterior cruciate ligament reconstruction (ACLR). It will also assess how test instructions influence lower limb stiffness and knee function and examine the effects of lower limb strength on fast stretch-shorten cycle (SSC) capacity. This will help clinicians make educated decisions in injured athletes, which may inform rehabilitation programs, athlete risk profiling, and return to sport.
Title: Development and dissemination of a freely accessible, online evidence-based learning module on the assessment, diagnosis and management of sports concussion in adults and children
Lead: Dr. Scott Howitt/Ontario Tech University
Impact: Canadian chiropractors have the clinical training to assess, diagnose, and manage concussion but there are few user-friendly clinical resources that aggregate this information into a digestible format. This learning module, targeted toward clinicians, will focus on general recommendations for assessment, diagnosis and management of concussion as well as recommendations for managing prolonged post-concussion symptoms.
Title: Bringing the athlete’s voice to sports healthcare – investigating and prioritizing athlete expectations, values, and preferences for care to cocreate practice toolkits to inform athlete-centred care.
Leads: Dr. Alexander Lee/Canadian Memorial Chiropractic College
Title: What can chiropractors do to support athletic performance? A focused ethnographic qualitative study of sports chiropractic clinical encounters.
Lead: Dr. Alexander Lee/ Canadian Memorial Chiropractic College
Impact: Athletes often seek chiropractic care to enhance sport performance and report positive outcomes. This study seeks to establish chiropractic’s unique value in sports healthcare settings by investigating approaches chiropractors apply when treating athletes, what is distinctive about these approaches and what opportunities exist to improve chiropractors’ ability to influence athletic performance.
Title: Linking physiological responses to clinical outcomes following cervical spine manipulation: a randomized mechanistic cross-over trial
Leads: Dr. Lindsay Gorrell & Martin Descarreaux, Balgrist University Hospital, University of Zurich & Université du Québec à Trois-Rivières
Impact: Spinal manipulation (SM) is an effective treatment for neck pain, but the mechanisms are not well understood. This international collaboration aims to develop a scientific approach to identify patients most likely respond to manual therapy by investigating the relationship between delivery kinetics, physiological responses, patient expectations and clinical outcomes following spinal manipulation.
Title: The development of the Diminishment of Expression of Personal and Inherent Values (DEPrIVe) Scale, a novel patient questionnaire assessing impacts of pain on the expression of personal values
Lead: Dr. Matthew Barrigar, Canadian Memorial Chiropractic College
Impact: Patient values are a critical element of evidence-based medicine (EBM) but few instruments exist in persistent pain management. This project builds on collected data gathered from focus groups of English-speaking patients by investigating values held by non-English speakers. Development of this instrument could lead to significant improvements in charting patient values and incorporating them into care plans for managing persistent pain.
Title: Attitudes toward chiropractic: a survey of Canadian sport and exercise medicine physicians
Leads: Dr. Cameron Borody & Dr. Janet D’Arcy, Canadian Memorial Chiropractic College
Title: Exploring pain-related disabilities among First Nations, Inuit and Métis in Canada
Lead: Dr. Pierre Côté, Faculty of Health Sciences, Ontario Tech University and the Institute for Disability and Rehabilitation Research
Impact: Among Indigenous peoples in Canada, conditions related to pain are the leading causes of disabilities, but too little research exists to understand their burden and impact. Working collaboratively with Indigenous peoples, this project aims to provide essential information to assist chiropractors and healthcare partners in understanding pain-related disabilities within these communities to develop evidence-informed, culturally agile care and interventions that respect Indigenous ways of knowing.
Title: Using ICF linking rules to catalogue characteristics of older adults with low back pain related disability
Lead: Dr. Aleisha Adeboyejo, University of Ontario Institute of Technology/Canadian Memorial Chiropractic College
Impact: This is the first study to link epidemiological and qualitative research of older adults with low back pain to the WHO’s ICF framework, which measures health and disability. This will assist chiropractors in the evaluation and management of their patients, improve comparison of global data across health disciplines and communication between health care workers, researchers, and other stakeholders.
Title: Systemic inflammatory biomarkers and brain functional connectivity: Identifying a neuroinflammatory signature in patients with idiopathic chronic neck pain?
Lead: Dr. Felipe Duarte, Canadian Memorial Chiropractic College
Impact: This study expands Dr. Duarte’s previously approved Functional magnetic resonance imaging (fMRI) project by adding a control group and blood inflammatory biomarker analysis which will evaluate the relationship between peripheral inflammatory biomarkers, brain functional connectivity, and clinical outcomes across all groups.
Title: Measurement of spinal mobilization biomechanical parameters in the preschool pediatric population
Leads: Dr. Isabelle Pagé & Dr. Chantal Doucet, Université du Québec à Trois-Rivières
Award: $25,000 Status: Complete
Lead: Dr. Peter Stilwell, School of Physical & Occupational Therapy – The Royal Institution for the Advancement of Learning/McGill University
Impact: Building on previous work, Dr. Stilwell seeks to fill an important gap by determining the first evidence-based definition of pain-related suffering. His multi-disciplinary team will combine qualitative, quantitative and knowledge transfer methodologies to help clinicians better understand how patients are affected by this experience.
Award: $10,500 Status: Complete
Leads: Dr. Nora Bakaa & Luciana Macedo, McMaster University
Title: C-prior: Implementation of the MAINTAIN instrument for patients with dysfunctional spinal pain – a randomized clinical trial
Partial Award: $45,000
Lead: Dr. Martha Funabashi, Canadian Memorial Chiropractic College (CMCC)
Impact: This randomized clinical trial will investigate the implementation of the MAINTAIN instrument in clinical practice and tracking its effectiveness and cost-effectiveness compared to standard chiropractic care.
Title: Does the use of paramedical health services influence the care trajectory of patients with chronic spinal pain?
Lead: Dr. Marc-André Blanchette, Université du Québec à Trois-Rivières (UQTR)
Impact: This project will provide valuable information for clinicians to improve care for chronic spinal pain patients; for professional colleges/associations to improve practice guidelines; and for decision-makers who need evidence to help determine optimal use of paramedical healthcare.
Title: The development of a global tracer indicator to measure effective coverage for rehabilitation of low back pain
Award: $29,800 Status: Complete
Leads: Dr. Jessica Wong/Dr. Pierre Côté, University of Ontario Institute of Technology
Title: Identifying spine care needs, and perceived barriers to accessing evidence-based spine care in northern Manitoba: A Global Spine Care Initiative implementation project
Leads: Dr. André Bussières/Dr. Steven Passmore, Université du Québec à Trois-Rivières (UQTR)
Impact: Pimicikamak, Manitoba (Cross Lake First Nation) has a largely indigenous population with underserved spine care needs. This project will determine the nature and impact of spinal disorders in the community and identify factors which may impact the community’s ability to adopt healthcare approaches intended to improve the health of its residents.
Title: Lived Experiences with Symptomatic Degenerative Cervical Radiculopathy: The Patients’ Perspectives
Award: $5,000 Status: Complete
Lead: Dr. Joshua Plener, Canadian Memorial Chiropractic College (CMCC)
Title: Adaptation of chiropractic care in the aging population: exploration of the views and beliefs of chiropractors
Leads: Dr. Isabelle Pagé/Dr. Julie-Marthe Grenier, Université du Québec à Trois-Rivières (UQTR)
Impact: This project will explore chiropractors’ perspectives on the clinical management, safety and effectiveness of chiropractic care for our aging population. This will be followed by subsequent studies to evaluate whether their beliefs are supported by evidence and whether other aspects should be considered.
Title: Quantitative Validation of the heat capsaicin model of pain induction for the low back
Lead: Dr. Diana De Carvalho, Memorial University of Newfoundland
Impact: This study explores the validation of pain induction for the purpose of studying low back pain (LBP). It’s the first study to:
1) validate the heat-capsaicin model of pain induction in the low back
2) to compare biomarkers in the heat-capsaicin induction and sitting-induced LBP induction procedures, and
3) to compare subjective pain ratings to these objective measures. The findings of this study will provide the foundation for future LBP research for decades to come.
Title: Promotion of Physical Activity by Postpartum Women with Lumbopelvic Pain
Lead: Dr. Heather Hollman, University of Victoria
Title: What is the effect of chiropractic or physiotherapy on medical health utilization and costs in adults with low back pain? A population-based matched cohort study.
Lead: Dr. Jessica Wong, Doctoral Candidate, Epidemiology Division, Dalla Lana School of Public Health, University of Toronto
Impact: This is the first study to assess the effects of chiropractic and physiotherapy on medical care utilization costs in Canada. This research leverages novel data that captures all medical encounters and direct person-level costs over a 15-year period in a population-based sample of Ontario adults with back pain.
Title: The role of sensitization and sensorimotor integration in understanding the biological basis of Chiropractic
Lead: Nicolas Antony, Ontario Tech University
Title: The clinical course of spinal pain in adolescents: a feasibility study
Lead: Dr. Michael Swain, Macquarie University, Parker University
Impact: This study will provide better understanding of adolescent patients with MSK pain and is an essential first step to conducting a definitive clinical cohort study on this important but under researched group. It will break new ground in the recruitment and follow up of young people seeking care and lead to new care models for early-on episodes of spinal pain that may inform preventative efforts to reduce the impact of chronic-recurrent spinal pain later in life. Testing will be done by multi-site team of collaborators in Canada and the United States.
Status: Awarded $50,000
Title: The Effect of Chiropractor Informed Triage vs. Usual Medical Management on Low Back Patient Outcomes and Trajectories in Tertiary Care Settings: a Controlled Clinical Study
Leads: Dr. Martin Descarreaux & Dr. Andrée-Anne Marchand
Impact: This is the first study in Canada to use randomized triage approach to measure the impact of chiropractors’ diagnosis and treatment on a patient’s trajectory through the public health care system. Patients with low back pain will be randomly referred to triage done by a chiropractor or directly to the neurosurgeon to see how integrating chiropractors into public health care services during triage could reduce delays as well as the number of non-indicated examinations and, consequently, contribute to improving the health of patients with low back pain.
Status: Awarded $63,000
Title: The Effect of Cervical Spinal Manipulation on Brain Functional Connectivity Using Magnetic Resonance Neuroimaging in Patients with Chronic Neck Pain
Lead: Dr. Felipe Duarte, Canadian Memorial Chiropractic College
Purpose: To track neuroplastic effects of a single cervical spinal manipulation – and SMT applied over time – on functional connectivity in the brains of patients with chronic neck pain.
Impact: This is the first FMRI study of its kind on the cervical spine which will provide important data needed to fill gaps in current knowledge. It’s also the first study that will measure both short and long-term effects of SMT on brain function and how these neuroplastic effects might change over time. This evidence may lead to a significant increase in credibility for the chiropractic profession.
Award: $10,000 Status: Complete
Title: Advancing the conceptualization and assessment of pain-related suffering
Lead: Dr. Peter Stilwell, McGill University
Purpose: To develop research supported understanding of pain-related suffering associated with MSK conditions and identify gaps in the way current literature defines and grades pain related problems.
Impact: This study seeks to discover how patients feel their suffering is prioritized by practitioners. This will lead to a better understanding of people with painful MSK issues, address gaps related to the assessment of pain-related suffering and improve the patient experience during the initial assessment and treatment.
Award: $44,000 Status: Complete
Title: The Association of Chiropractic Integration with Opioid Use for Chronic Non-Cancer Pain in an Ontario Health Care Centre: A Mixed Methods Study.
Lead: Dr. Peter Emary, McMaster University, Departments of Health Research Methodology; Michael J. DeGroote Institute for Pain Research and Care
Purpose: To examine the relationship between chiropractic integration and opioid use among vulnerable patients in a Community Health Centre (CHC).
Impact: This study directly addresses one of the country’s most pressing public health crises – opioid addiction. It’s the first study of its kind to track whether the receipt of chiropractic services can reduce opioid use among patients already using prescription opioids. It also seeks to identify improvements in quality of life and other qualitative areas that may prove unique to chiropractic intervention and help validate outcomes seen in practice.
Award: $16,000 Status: Complete
Title: Tracking the impact of clinical care among patients with chronic lower back pain: the utility of performance-based measures of physical function and impairment
Lead: Dr. Sheilah Hogg-Johnson, Canadian Memorial Chiropractic College
Purpose: To determine how specific performance-based measures correlate with disability reported by patients with chronic lower back pain.
Impact: The goal of this study is to determine whether patient assessments can be improved by adding function tests to questionnaires and to see if changes perceived by patients are supported by functional changes. This will help chiropractors assess patients more effectively and improve patient satisfaction. This team includes high level female investigators and is an international (Danish) collaboration.
Award: $5,000 Status: Complete
Title: Is there a correlation between NMSK disorders and breast pain in breast feeding mothers seeking chiropractic care: A case series
Lead: Dr. Chantale Doucet, Université du Québec à Trois-Rivières
Purpose: To investigate the association between nipple pain and MSK dysfunction
Impact: The biomechanics of breastfeeding and post partum body changes are areas in need of research. In addition to providing much needed data for chiropractors and the profession, this study addresses a broader issue beyond MSK and will lay critical groundwork for future studies and trials.
Status: Awarded $52,000
Title: Is a funded, integrated pathway for low back pain a feasible way to shift health resource utilization from low value to high value care?
Lead: Dr. Greg Kawchuk, University of Alberta
Purpose: This study seeks to compare a pathway of evidence-based treatment for patients with lower back pain against the standard of usual care.
Impact: Governments and health insurance companies spend a significant amount of money on treatment for patients with chronic lower back pain. This study seeks to discover whether providing evidence-based treatments resolves patient’s issues more effectively and reduces their cost of care.
Status: In Progress
Title: Reducing wait times, opioid prescriptions and imaging rates for acute and chronic spine pain patients: A university-hospital based chiropractic clinic implementation project.
1) Determine potential barriers to managing spine pain patients without opioid medication and spine imaging prescriptions;
2) the factors related to referring these patients to hospital-based chiropractic care
3) to evaluate the impact of knowledge translation (KT) interventions combined with guideline informed chiropractic care on reducing ED and SAC opioid medication and diagnostic imaging prescriptions, ED wait-time, and patient health outcomes.
Chief Investigator: Dr. Steven Passmore Hons BKin, MS, DC, PhD
Award: $250,000 CAD over 3 years
Status: In Progress
Title: Understanding health care utilization for musculoskeletal disorders and disability in Canada: A population-based perspective.
1) Determine which health care providers Canadians consult to manage MSK pain
2) Describe the characteristics of Canadians who consult different types of health providers for MSK disorders and disability.
Chief Investigator: Dr. Pierre Côté, Faculty of Health Sciences, Ontario Tech University, and Centre for Disability Prevention and Rehabilitation at OTU and CMCC
Award: $59,548 CAD
Status: In Progress
Title: Advancing Patient Safety for Special Populations: Active Surveillance Reporting to Identify Adverse Events Following Chiropractic Care in Older Adults
Goal: This 3-part study will investigate changes in symptoms reported by older adults receiving chiropractic care, with a focus on safety.
Chief Investigators: Dr. Martha Funabashi BSc, MSc, PhD Clinical Research Scientist and Assistant Professor CMCC, Toronto, Ontario and Dr. Katharine Pohlman, Director of Research, Parker University, Dallas, Texas, USA
Award: $50,000 CAD
Title: Operationalizing ‘whole person’ pain care
Goal: To develop practical evidence-based resources, including a collection of whole patient care principles, themes, and strategies clinicians can use when interacting with their patients experiencing pain.
Chief Investigator: Dr. Peter Stilwell, Dalhousie University, Halifax, Nova Scotia
Award: $25,000 CAD
2000 to 2017
Chiropractic Research Chair and Scholarship Program
CCRF backed research teams have been established on Canada’s most prestigious campuses, publishing
findings in recognized medical journals while building strong ties with colleagues in adjacent health care