The ICPA recognizes Evidence-Informed Practice to be a thoughtful integration of the best available research, coupled with clinical state and circumstance, and patient preferences and actions.
A frequent criticism of the evidence-based practice model (as opposed to evidence-informed practice) is the heavy reliance on published evidence from randomized controlled trials (RCTs).1 This evidence-hierarchy is aligned with a post-positivist philosophy of research. The post-positivist paradigm of research is based on an ontology that it’s a material world, that our senses cannot be trusted and an epistemological approach towards objectivity. Indeed, the true experimental design of RCTs endeavors to eliminate (or at least distribute equally) the known and unknown biases with randomization, the presence of a control from which to compare an intervention and manipulation of various independent clinical variables that may affect outcome. This philosophical approach to research has inherent limitations and poses challenges to chiropractic research. Consider the challenge of creating a valid sham SMT.2 How does one provide a true sham adjustment?
We do not discount the importance of this philosophical approach to research but rather raise the option that alternative research approaches must be utilized when examining evidence-informed chiropractic practice.
Towards such efforts we embrace the research philosophy of constructivism. With an ontology that reality is constructed by individual perception, that there is no absolute truth or validity but rather truth is relative and subjective and based on perception or some particular frame of reference. The epistemology is one where research emphasizes the meaning of the human experience and objectivity is not the desired goal.3 Constructivism is coherent with evidence-informed practice in that it acknowledges the individual and collective clinical experience of chiropractors as well as the myriad factors (i.e., cultural and religious norms) that affect the needs and desires of people for the type of care that they want.
As such we at the ICPA provide an evidence-informed perspective in terms of the published research evidence, showcase the clinical experience and expertise of chiropractors and provided evidence that indeed, chiropractic is congruent with the needs and wants of our patients.
— Joel Alcantara, DC, ICPA Research Director
