The Ontario Chiropractic Association (OCA)’s Evidence-Based Framework Advisory Council (EBFAC) works to develop a comprehensive and inclusive understanding of chiropractic care. Formed in 2019, its work is grounded in building a critical foundation for how a description of chiropractic that embraces the continuum of care can be developed and communicated. From this foundation, the OCA will be partnering with organizations to build practical resources for all chiropractors in Ontario.
Read about our work to date: June 2022 | July 2021 | December 2020
“Over the course of our work for the past two years, one of the biggest shifts for me in my understanding of evidence-based chiropractic care has been the importance of clinical expertise. It’s a concept that’s truly interwoven in and underpins all areas of evidence-based care. Clinical expertise grows over time with practice experience, with ongoing professional development and in learning from patients.”
“I think this work will have reach far outside of the chiropractic profession, potentially becoming a benchmark for other health care professions to follow. At some point, I began to think that traditional chiropractors weren’t as welcome in the profession as they used to be. The concept of ‘evidence-based chiropractic’ is a game changer for our field and how we care for our patients. I look forward to practising under this model.”
“As chiropractors, I feel that we’ve always been good at applying clinical expertise, drawn from our own experiences, and respecting our patients’ values and preferences. However, I think that there’s always been room for improvement in incorporating the best available research into our practice. As a result of this work, I look forward to seeing advancements in how clinicians understand, interpret, and apply best available research evidence in managing their patients.”
“As a patient, before I became involved in this work, I didn’t have any thoughts about evidence-based chiropractic care. But by serving on this council, I realized that current research should be applied in clinical settings. I think many patients would like to know how their chiropractor formulates their treatment plans and what evidence they use to create them.”
“When I began my practice, evidence-based care hadn’t yet been developed and many professionals, like me, had to do the best they could on their own. Our work to date gives chiropractors the format and foundational pieces to synthesize available research and apply it to their practice. I’m confident that these tools will help move our profession forward.”
“I used to believe that the definition of evidence-based care was solely based on randomized control trials (RCTs). To me, this definition was limiting, divisive, and judgemental. With this work, we now have a true paradigm shift for evidence-based care that’s empowering and provides an equal footing for patient preference and doctors’ clinical experience for best available evidence.”
“Throughout this work, I’ve been delighted to see ‘patient preference’ and ‘clinical expertise’ on the same stage as ‘best research evidence’ when defining evidence-based care. I think more often than not, many people focus on randomized control trials when it comes to defining evidence-based care. In the absence of clear guidance, it’s encouraging to be able to incorporate our own experiences with patients, along with their preferences, to provide exceptional patient care.”
“The notion of evidence-informed practice is something that still resonates with me to date. We can learn a lot from one another’s clinical experience. In this end, this is what truly unites me to all forms of chiropractic.”
“Many of my patients present with conditions for which evidence is currently lacking. For this reason, I never thought I could label my practice as evidence-based. I now realize I can because I’m already doing the steps that are necessary. It’s comforting to know that what I consider real traditional chiropractic practice can fit into this model.”
“Coming into this process, my understanding of evidence-based chiropractic care was that in order to provide effective patient-centered care, there needs to be integration between clinical expertise and the highest level of research evidence. Over the course of this work, I’ve come to appreciate that evidence-based chiropractic care is a dynamic approach that integrates best-available evidence, clinical expertise, and patient preference, which, combined is crucial in delivering safe and effective patient-centred chiropractic care.”
“About 25 years ago, research showed that only 30 per cent of the profession was evidence-based, which was comparable to other professions at the time. Now, here we are, breaking ground with a mission to set a comprehensive and inclusive definition of chiropractic care. With our work to date and moving forward, I hope we can continue to help increase the number of practitioners embracing evidence-based care in their practice.”
“Our work has helped me bridge the gap between practice and research; reiterating the importance of evidence behind how and why certain strategies can help patients in their recovery. If there’s anything I’d like to see moving forward is for us to broaden the types of research we investigate, where we should be going next, and how this fits into a bigger evidence-based care model we can all follow.”
“I used to feel that evidence-based care was used as almost a polarizing term for some practitioners. It’s been a humbling learning experience to see that what we’re actually doing is not meant to separate or polarize any particular group but bring us together so we can be successful professionals in our field.”
“I’m proud of how far we’ve come over the last two years, arriving at a comprehensive model of evidence-based practice. However, we must continue to remain flexible and dynamic in our thinking as more research becomes available and when interacting with our patients. It’s important to remain fluid as we move forward, appreciating that the various pillars of a comprehensive evidence-based care model can and will change.”
OCA EBFAC Milestones
- Engages in several rounds of consultation with working groups and key stakeholders to provide input into the work.
- Work is ongoing to finalize all papers with authors and prepare submission for peer-review publication.
- Adopts the Haynes (2002) model, recognizing the evolution of thought around EBP. This model uses clinical expertise as the lens to integrate the components of patient preferences and actions, clinical state and circumstances, and research evidence.
- Completes engagement with other organizations to obtain feedback on the patient preference paper.
- Develops a paper exploring the evolution and interpretations of the evidence pyramid in reflecting the modern understanding of best available evidence.
- Begins work on the clinical expertise paper.
Haynes’ (2002) four-part model, adopted as EBFAC’s preferred model of EBP
- Explores David Sackett et al.’s model (1992) of evidence-based practice (EBP) to guide its work. Known as the “Sackett model”, it defines three pillars of EBP as research evidence, clinical expertise, and patient preferences.
- Reviews three areas of focus of patient preference and expectations and embarks on a deep analysis of the latest research on the best available evidence pillar.
- Investigates the importance of the research question in determining research study design.
- The OCA launches the Evidence-Based Practice Framework strategic project and establishes the advisory council.
- Council holds its first inaugural meeting and subsequent virtual updates.
- Early work focuses on collaborating with partners, influencers, and subject matter experts.
OCA EBFAC Members
The OCA EBFAC is comprised of 13 members and one patient member:
- Dr. Sean Batte (Logan University graduate; practising in London area)
- Dr. Ken Brough (Palmer College of Chiropractic graduate and practises in Ottawa)
- Dr. Anita Chopra (New York Chiropractic College graduate and practises in Brampton, Oakville and Etobicoke)
- Dr. Marco De Ciantis (CMCC Graduate and practises in North York)
- Dr. Peter Emary (New York Chiropractic College graduate and practises in Cambridge)
- Dr. Brian Gleberzon (CMCC graduate and practises in Toronto)
- Sheila Gregory (patient member)
- Dr. Glen M. Harris (CMCC Graduate and practises in midtown Toronto)
- Dr. Deborah Kopansky-Giles (CMCC graduate working in Greater Toronto Area)
- Dr. Keshena Malik (CMCC Graduate and practises in the Hamilton area)
- Dr. Bernadette Murphy (CMCC Graduate and practises in the Greater Toronto Area)
- Dr. Paul Nolet (CMCC graduate and practises in Guelph)
- Dr. Antonio “Tony” Ottaviano (Life University graduate and practises in the Niagara area)
- Dr. Rod Overton (CMCC Graduate and practises in the London area)
Click here to read the full council member profiles.