Outcome Measures in Chiropractic Research: How Do We Choose Health Services Clinician-based Measures?

As health care costs continue to escalate in the U.S., there is renewed pressure on both payers and providers to demonstrate that the services provided by all clinicians are cost effective. There is a renewed emphasis on quality of patient care, manifested through an increasing demand for evidence based medicine demonstrated through performance measurement. Outcome assessment normally used in research can support the therapeutic process by tracking patient symptoms and function and offering a common language to clinicians and researchers. This study's objectives were to: (1) identify clinician-based outcomes assessments (CBOA) and health services measures used in published chiropractic studies, (2) describe a framework for identifying appropriate sets of measures, and (3) address the challenges associated with these measures relevant to chiropractic. . METHODS: This study was a literature review to identify and evaluate the most commonly used to outcome measures in chiropractic research. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity and responsiveness to clinical change. A total of 629 abstracts were reviewed using PubMed and Index to Chiropractic Literature (from inception to June 2006). RESULTS: A total of 1,166 citations were identified. Of these, 629 were selected as relevant. The most common CBOA instruments identified were radiography, range of motion (ROM), pain threshold, and strength testing (ST). The most common health services measure identified were medication use, recurrence rate, direct and indirect costs (including sick-leave), health care consumption, and type/number of treatment administered.

Less common CBOA and health services measures were also assessed.