approach, and many of the randomized controlled trials that were done at the time didn’t have high quality methodology.” The bread and butter of Cochrane groups are systematic reviews. These research studies are conducted according to a format designed to be as scientifically rigorous as other forms of research such as experiments and trials. In a systematic review, researchers set out with a clear question: “What’s the effectiveness of intervention X on those with condition Y?” They thoroughly search the scientific lit-erature for the best available evidence on that question. They then review the studies carefully to grade each for the quality of the study design (were there control groups?), the strength of its findings (might there be other explanations for the re-sults?) and so on. The goal is to synthesize the available research for a wide audience – patients, clinicians, policy-makers and other scientists – and give them a sense of what works and what doesn’t. The reality tends to be less black and white, says Furlan. It is not often systematic reviews can say in a sweep-ing manner whether a given intervention works. It might work for a subset of patients but not another. Or, it might work in the short term but not the long run. “Most of the interventions we’ve reviewed don’t fall into black and white boxes. They fall into a grey box in the mid-dle. But even that is helpful,” says Furlan. “It’s helpful to patients and clinicians to know which treatments are in the grey zone, because it means that they could still try them. An intervention that doesn’t work for one person may still work for someone else.” The scope of the group’s work is also expanding. In the early years, Back Group reviewers focused mainly on inter-vention treatments, and relatively little work was done on ways to diagnose and predict the outcome of the condition. Today, the Back Group is starting to tackle different types of reviews. Furlan is now reviewing studies on opioid treat-ments to look for adverse outcomes. The group is also starting to assess the effectiveness of interventions in relation to cost – a real-world concern that hasn’t always been re-flected in the scientific literature. “The thinking about back pain has evolved tremendously,” says Bombardier. Increasingly, researchers and clinicians are starting to view back pain not as a one-time occurrence but as a recurring condition. From that perspective, researchers will need to do more long-term follow-up work to under-stand the different patterns of recurrence experienced by patients. “Most of the trials currently aren’t taking this into account.” Furlan knows that, to the non-scientific world, progress on back pain may seem slow. She is optimistic, however, that the work of building evidence will matter over time. Canadian Memorial Chiropractic College Practice OpportUnity‘14 Thursday, February 20, 2014 12:00 – 3:30 p.m. CMCC — CCPA Hall Recruiting...selling...seeking employment? Are you a chiropractor looking for an associate or a buyer for your practice? Are you a company looking to sell or promote your product or service to students who will soon be in practice? Join us for Practice OpportUnity ‘14 and network with over 300 chiropractic students, interns, recent graduates, and faculty. The profession is invited to visit the tradeshow from 2:30 -3:30 p.m. A great opportunity to see your suppliers and meet new ones. Attend in person or send in your practice opportunity for display. Space is limited and allocated on a first come, first served basis, so book today! Silver Sponsors: Canadian Chiropractic Association, Heel Canada, The Orthotic Group Bronze Sponsor: Footmaxx Media Sponsor: Canadian Chiropractor Magazine For exhibitor information, sponsorship, or to register: Web: www.cmcc.ca/ PracticeOpportUnity Phone: 416 482 2340 or 1 800 669 2959 ext. 200 Email: [email protected] www.canadianchiropractor.ca December 2013 Canadian Chiropractor 39
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