How university-based research will take chiropractic to the world. An interview with Dr. Jill Hayden, DC, PhD
It was 1986 when I first stepped into Toronto Western Hospital. I remember dark halls and how the heady smell of the aging construct combined with disinfectant to make me feel that I was in a hallowed place. My favourite section became the old Bell Wing – the original building that had been erected in 1899. It was the type of set-up you see in First World War movies with about 20 beds lined up in one big common hallway and only thin curtains to shield patients from each other. The head nurse, white, starched dignity anchored upon a sculpted coiffure – as a unit, they gave her a papal air – was sentinel to the rules and regimens that defined that world.
In the decade that followed, Toronto Western grew from a tribute to history into a piece of modern architecture, an indispensable member of Toronto’s University Health Network and a flagship teaching and research facility. Today, I’m greeted by an exterior door that glides open quietly and nobly before me – I recall the throaty grind of the old entrance – revealing a world where inquiry and discovery are suggested by the open, sunny concept of the current design.
On the fourth floor of the Fell wing, the presence of Dr. Jill Hayden, a chiropractor – the third to receive the distinction of CCRF/CIHR Chiropractic Research Chair – is not only testimony to how “The Western” has moved forward and but also to how chiropractic is becoming a valued element of health care in our country.
After we’ve settled at her desk, Dr. Hayden, unassuming and friendly, begins to describe why she was led into a career in chiropractic research. Taught from an early age to challenge and question the world around her, Dr. Hayden came to CMCC in Toronto in 1991 and proceeded to gain her degree there. On her first day, she encountered Dr. Silvano Mior, then Dean of Research at the school, whom she describes as an important mentor to her. She was impressed with how he encouraged the students to challenge what they would hear in the coming four years. Although Hayden had not actually planned a career in research, other mentors came to inspire her into this area. In particular, Dr. Peter Kim, who encouraged her to enter the Clinical Sciences Residency Program – where research is a mandatory component – has remained a substantial influence. Before long, Dr. Hayden came to see that research was not only an exciting frontier for chiropractic but, also, a way to push important boundaries of care and, ultimately, to influence patient outcome.
“I love coming to work each day!” is how this energetic researcher, and mother of two, describes her career. “The more you know, the more you realize you don’t know,” she adds.
And this serves as a hint of things to come regarding how Dr. Hayden sees the role of research in chiropractic today.
Hayden’s work and goals
As her training is in chiropractic, Hayden’s work naturally focuses on back and neck pain. Hayden’s PhD thesis involved work on prognosis and systematic review. Systematic review is a research method that makes sense of existing literature – the similarities, discrepancies and the conclusions – by reviewing studies that have already been published. By centring on prognostic studies, Hayden feels her work can help improve our under-standing of disease processes and help chiropractors make the best patient management decisions. This includes identifying characteristics of patients that make them do better, or worse, with chiropractic.
“Back pain, headaches and neck pain are complex conditions,” says Hayden, “ and research studies have shown that simply diagnosing and treating these conditions has shown a limited level of effectiveness.” Hayden looks at modifiable predictive factors that would point to possible new interventions that would work on a particular patient. This not only provides more effective patient-centered care but also serves to entrench chiropractic as a credible member of the healthcare community.
Hayden’s interest in continuing
to pursue prognostic research has made her the leader of the Prognosis Research Team at the Centre of Research Expertise in Improved Disability Outcomes (CREIDO), Uni-versity Health Network. She feels that by entering into research efforts, and becoming leaders in those efforts, chiropractors will grow to become a strong voice in our health-care system.
“We can be part of the team,” she says without hesitation, “we have to be leaders and the voice of knowledge for the conditions that we treat.”
More chiropractic researchers are needed
Dr. Hayden feels that it is important to be integrated into healthcare research to avoid the possibility of the profession disappearing. Chiropractic must take on a leadership role through research now! Hayden notes that the reality of health care, in our times, is that evidence, research and science will define what treatments are going to be accepted and paid for. As well, with the public becoming more knowledgeable about looking at evidence, chiropractic research needs to be present in order to have a voice within the system.
“However,” she cautions, “we are not at that critical mass of researchers for chiropractic yet.”
At this time, there are chiropractic researchers in several different areas, including epidemiology. The numbers are still small, however, and Hayden states that the profession must continue to work at growing these numbers.
“As the mass of researchers grows, then we can meet and collaborate more. This cross-disciplinary communication will lead to more innovations in patient management and in understanding the mechanisms of what we do.”
“When we reach a broader under-standing for ourselves, we will see more clearly how to innovate clinical practice.”
Chiropractors as leaders
Furthermore, notes Hayden, will turn to us as experts on musculoskeletal conditions.
For their foresight in developing a government-supported, university-based, connection for chiropractic research, Hayden commends Dr. David Petersen and, especially, Dr. Alan Gotlib.
“In university-based research, you are all on a level playing field – you’re recognized as being an expert, whether you’re a chiropractor, a physiotherapist or an MD. Research is the language through which we can be on a level playing field and take a leading role!”
This, she says, will lead to shifts in currently perceived clinical hierarchies where chiropractors are not usually looked at as leaders in their area of work.
Growing a research culture for students and clinicians
Dr. Hayden sighs as we move on to talk about how to bring research into chiropractic education and into the field.
“Clinicians get frustrated with research,” she says, not without empathy. “Researchers are hesitant to create big messages and draw conclusions because research teaches you to ask better questions, not to find answers! You learn to refine your question for next time and try to get a better answer.”
“You must use science to develop theories and not theories to guide science,” says Hayden, “and the answers are not always what clinicians want to hear.”
And so, Hayden admits, the question of “how does that help me in practice?” that comes from clinicians presents a special challenge.
The solution, Hayden suggests, must begin prior to entering chiropractic education and, then, continue through chiropractic training. Applicants to chiropractic programs must be required to complete a degree at the university level – this provides new students with the groundwork to question and challenge, as well as to understand and utilize research, before they enter into chiropractic education. It is important that, while training to be chiropractors, a culture of research must be supported so that, by the time doctors are ready to practise, they are comfortable with making evidence a part of their decision making. This will make them more effective practitioners and a more credible source of knowledge, for their patients, on the conditions that they treat.
Hayden returns to her point about striving for a critical mass of researchers in chiropractic. She emphasizes that those students who want to pursue a career in research should be encouraged to do so. She envisions greater numbers of researchers that can, in turn, act as mentors to future students.
Hayden then goes on to discuss support for continuing education in research for chiropractors. Clinicians need to be reminded how to question and how to stay connected. They should learn how to recognize good and bad research studies and when to trust results. Research conferences should be attended in order to give practitioners an opportunity to interact with their peers as well as with researchers in their profession. She notes, at this point, that fostering this clinical practice-research connection is as much the responsibility of researchers as it is of the clinicians themselves.
Finally, Dr. Hayden describes the knowledge transfer and exchange (KTE) efforts that are currently underway in health-care research. Hayden, herself, has been a part of efforts to study how to best take the knowledge derived through research to the field clinician in an effective manner.
“It used to be that researchers would complete their study, have it published, and leave it to practitioners to find it, read it and utilize it,” Hayden recounts, “But KTE is a big part of most research departments now. There has to be a link with the people who are going to use the research. The struggle is in developing those links.”
Chiropractic must be ‘at the table’
“In health care, policy decisions are made based on who is at the table,” says Hayden, when asked for a closing comment. “It’s not that policy makers want to exclude chiropractors but there hasn’t been enough reason to ask them. If you become recognized as a research expert in the field, then you will be invited to give your opinion.”
And this, she feels, is how chiropractic will become an essential component of health care in our country.
“Integration will not be a concern if we remain leaders in what we do.”
Dr. Hayden’s message is that through continued support for university-based, chiropractic research – both from government sources and within the profession and its educational institutions – as well as through fostering of a culture of questioning and challenging, chiropractors can become, and remain, leaders, and a credible voice, in a very important area of health care.•
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