Editor's note: The first three letters were written in response to "The Building Blocks of Wellness" in the publisher's "Report of My Findings" (June 29th issue).

Conducting Valid Research on Wellness and Health Care

Dear Editor:

The solution of "How do we get out of this box?" (referring to the pigeon-holed concept of chiropractic as a treatment modality for low-back pain and other musculoskeletal categories of care) is of interest.

I find it curious that no reference was made to the landmark study conducted by Blanks, et al.¹, which represented possibly the largest study of wellness and quality of life issues yet conducted with regard to an approach practiced by chiropractors. The study was carried out under the most rigorous conditions. Careful attention was paid to proper methodology and interpretation of statistical significance, including validity assessments of the components of the questionnaire used in the retrospective analysis of 2,818 patients under network care.²

It is clear that the public at large is seeking participation in disciplines that proclaim to represent a "wellness" model.³ However, the onus of actually demonstrating that "wellness" accompanies or follows a particular mode of care is a far cry different than simply to "add wellness questions to a survey or Oswestry form," as was suggested in the Dynamic Chiropractic article. There is a large responsibility on those conducting research to use valid instruments when assessing health.⁴ If this is not done, then there is simply an accumulation of data that is seen by the research community as having little to do with actually identifying "wellness" or positive changes in the quality of life issues with the care received.

I was pleased to read of the admonition for the profession to join those in chiropractic who have already published research investigating the association between "wellness" and improvement of overall quality of life in association with Network Chiropractic. Moreover, I also encourage the chiropractic research community, and others who will also engage in this level of research, to peruse the study authored by Blanks et al. for sound methodology in this area of study.

References

1. Blanks RH, Schuster TL, Dobson M. A retrospective assessment of network care using a survey of self-rated health, wellness, and quality of life. Journal of Vertebral Subluxation Research 1997;1(4):15-31.

2. Epstein D. Network spinal analysis: a system of health care delivery within the subluxation-based chiropractic model. Journal of Vertebral Subluxation Research 1996;1(1):51-59.

3. Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States: prevalence, costs, and patterns of use. New England Journal of Medicine 1993: 246-252.

4. McDowell I, Newell C. Measuring Health: A Guide to Rating Scales and Questionnaires. New York, Oxford University Press, 1996.

Ralph Boone, DC, PhD
Editor, Journal of Vertebral Subluxation Research
Chandler, Arizona

Dear Editor:

I came across your article in the June 29th issue of DC, "The Building Blocks of Wellness." Nicely done!

I completely agree with you that large-scale wellness studies over many years are necessary to establish research in this area. I wanted to let you know, if you didn't already know, that wellness studies in chiropractic that include wellness and quality of life scores are and have been conducted.

One such study was a retrospective study published in the Journal of Vertebral Subluxation Research, vol. 1, no. 4, 1997.

Over the past year, my office has also taken part in the longitudinal study, which is being conducted by the University of California, Irvine. The results of that study may be published next year.

Thank you so much for your vision and insight.

Lisa Lewis, DC
Dallas, Texas

Dear Editor:

I am finishing my first year in practice. I have been through many challenges, and one which I embrace completely is educating people that chiropractic is more than what they have been told by the media and even other chiropractors. Wellness is our primary focus. Wellness in our office means helping their bodies and minds function at their fullest potential whether or not they are expressing symptoms. We recognize that everyone deserves an improvement in quality of life, even if they do not have musculoskeletal pain, low back pain or headaches.

I enjoyed reading your "Report of My Findings" in the June 29th issue of Dynamic Chiropractic, and honestly, reading this words coming from this publication was very surprising, and actually made me laugh. Judging from the material and advertisements in this publication, any chiropractor can easily see that the models of wellness, enhancing quality of life, etc., are not supported in this publication. For the profession to be up to the challenge of promoting wellness and quality of life, not as a by-product of chiropractic, but as a goal of chiropractic care, we have a lot of growing up to do. This means not being afraid to tell our patients and other health care professionals about the true wellness benefits of chiropractic.

It may interest you to know that the steps outlined in your article for documenting quality of life changes in those under chiropractic care are already underway. One study has recently been published, a retrospective study, and another, a longitudinal study, is currently ongoing. The research is being conducted by the Association for Network Chiropractic (ANC) in conjunction with the department of anatomy and neurobiology at the University of California-Irvine. Anyone who wishes to financially support wellness research to spread the message about all the benefits that chiropractic care has to offer can do so by contacting the ANC at (303) 678-8101. Reprints of the retrospective study are also available from the ANC.

Wouldn't it be wonderful if we could say to everyone without a doubt that chiropractic care improves the quality of life?

Brian P. Dickert, DC
Pittsburgh, Pennsylvania
enhanceyourlife-juno.com

Dear Editor:

A few days ago, I overheard one of my assistants telling another that chiropractic is illegal in Florida. I asked her why she would say something like that, and she replied that she read about it in our chiropractic newspaper. I retrieved the June 29, 1998 issue of Dynamic Chiropractic and she said, "There it is on the front page."

Considering that more than 50,000 DCs, students, suppliers and numerous others read this, it is disturbing to think that some may believe it is now illegal to practice chiropractic in Florida.

Although the attorney for the Florida Chiropractic Association clarifies that Florida is "one of the bellwether states in the country when it comes to advancements in chiropractic legislation and regulation," the commentary made by the president of the ICA is quite misleading, if not inaccurate. Captions like "chiropractic now illegal in Florida" on the cover of this issue, and again boldly printed on pages 13 and 20, will give some who do not know the players nor the issue the wrong impression.

Pioneers like my late father, who practiced 20 years without a license in Louisiana, would in my opinion view the events in Florida as our future. Chiropractic medicine may be the ultimate oxymoron, however, the goal of greater parity and accessibility to the wonderful benefits of chiropractic care and greater respect for those who practice our profession demands that we correct the loopholes.

Why do so few want us to remain unchanged and isolated? Since there are usually two sides to every story, my concern is that some will get confused by those who steadfastly resist change. Could that be a reason why our progress has been so slow? Another reason is that half of the profession does not support the profession on the national level.

The winds of change are swirling around our profession, and I am confident that the essence of naturally right chiropractic will remain pure as we move into the 21st century. I assured my assistant that chiropractic was indeed alive and well in Florida.

J. Michael Flynn, DC
Houma, Louisiana
flynn-cajun.net