1. Article Dissection
Patients with Multiple Sclerosis and Parkinson’s Disease Undergoing Upper Cervical Chiropractic Care

2. Questions to ask yourself
CRITICAL READING
Questions to ask yourself
Does the author clearly state his/her research question?
Is the study design appropriate to address the research question?

3. CRITICAL READING Methodology Was randomization performed?
Was a control group needed to address research question?
Was there inclusion and exclusion criteria?

4. CRITICAL READING Methodology
Were pertinent patient characteristics utilized?
Were appropriate outcome measures utilized for clinical measurements?
Were the test instruments reliable and valid?

5. CRITICAL READING Discussion
Did author identify limitation and biases of the study?
Did author discuss how limitations and biases may influence the results?

6. CRITICAL READING Conclusion
Did conclusion relate to the purpose of the paper?
Was the generalization appropriate?

7. CRITICAL READING References
Are the references from quality peer reviewed journals?
Are the references adequate and appropriate?
Are the references current?

8. What type of study is this?
CRITICAL READING
What type of study is this?
Descriptive
Observational
Random controlled trial

9. CRITICAL READING What is design of study? Case Report/Series
Case Control Study
Cohort
Cross-sectional
Longitudinal

10. CRITICAL READING
Case reports cannot inform the reader whether the intervention is generally effective for the complaint in question. If natural history and placebo effects are potential confounders, then it would be difficult if not impossible, for the report to draw any firm conclusions regarding the effectiveness of the intervention.
How to appraise research (2003) Hagino, C. China. Churchill Livingston p 1.10

11. CRITICAL READING Case reports can:
Have educational value regarding rare conditions or unique treatment protocols
Help to document what chiropractors are actually treating
Are good springboard for further, more confirmatory study or research.
How to appraise research (2003) Hagino, C. China. Churchill Livingston p 1.10

12. CRITICAL READING Internal Validity
The approximate truth about inferences regarding cause-effect relationships
Only relevant in studies that try to establish causal relationships
Not relevant in most observational or descriptive studies

13. CRITICAL READING Establishing Cause & Effect Temporal precedent
Must be able to show cause happened before effect
Covariation of the cause and effect
Before can show causal relationship, must show that there is a relationship
No plausible alternative explanation
Because there is a relationship does not mean it is a causal one

14. Article Critique by JACA
Triano, McGregor
Retrospective case series with no control
Suffers extensively from:
over-reaching hypotheses
bias
misrepresentation

15. Article Critique by JACA
Adams
No information on diagnosis of MS and PD and whether based on acceptable diagnostic criteria
Does not provide sufficient evidence or adequate references of tests to identify upper-cervical subluxations
Use of unvalidated outcome measures with ambiguous meanings
Author does not describe limitations of retrospective study design

16. Article Critique by JACA
Dana Lawrence
The treatment results are meaningless,
One case report cannot lead to any conclusions,
Eighty-one case reports cannot lead to any conclusions,
Without developed controls for meaningful data collection, this all means nothing.
(Former editor of JMPT)

17. “This paper is not a research report and cannot support its contentions.”
No sample, despite she reports 81 cases
There are no inclusion and exclusion criteria
There is no detailed methodology
The diagnoses cannot be confirmed
There is no causal link demonstrated

18. Dana Lawrence continues….
Given the number of problems in this paper, perhaps, the most important question to ask is, where was the oversight, both from the peer reviewers and from the editor?
(Erin Elster is a peer reviewer for JSVR)

19. Triano, McGregor
need in profession to expend greater effort in training our clinicians:
critical thinking skills,
the basics of clinical research,
critical appraisal of the literature.
The purpose of good research is
to protect against fooling ourselves, first.