We conducted a modified Delphi consensus study [17, 18] to determine the views of representatives from Canadian chiropractic organisations and stakeholder groups about research priorities for the Canadian chiropractic profession. Three online Delphi survey rounds were conducted, and one face-to-face workshop, to generate and judge the importance of research areas. This was followed by a final online survey using a pairwise ranking activity to prioritise research areas in order of importance [19].
Establishment of the Delphi panel
The Delphi panel was established with the aim to include representatives from all major stakeholder groups in the Canadian chiropractic profession. In consultation with Board members of the main stakeholder for this project, the CCRF, key organisations and groups were identified. Individuals from the following organisations and groups were invited to participate in the project, and included, where relevant, the Chief Executive Officer, the President/Chair, and Board Members:
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1.
CCRF
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2.
La Fondation Chiropratique du Québec
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3.
Canadian Chiropractic Association (CCA)
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4.
Canadian provincial chiropractic associations and regulatory authorities
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5.
Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (Federation)
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Canadian chiropractic educational institutions: Canadian Memorial Chiropractic College (CMCC); and Département de chiropratique, Université du Québec à Trois-Rivières (UQTR)
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Specialty Canadian chiropractic colleges recognised by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards:
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a.
College of Chiropractic Sciences
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b.
College of Chiropractic Orthopedists (Canada)
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c.
Chiropractic College of Radiologists
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d.
Canadian Chiropractic Specialty College of Physical and Occupational Rehabilitation
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e.
Royal College of Chiropractic Sports Sciences (Canada)
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8.
Canadian Chiropractic Protective Association (CCPA)
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Active researchers with a chiropractic background, including past and present chiropractic Research Chairs, and PhD students
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10.
Chiropractic student associations at CMCC and UQTR
Delphi panel member recruitment
Eighty-five individuals representing these chiropractic organisations and groups were invited to participate in the Delphi panel. Invitations were sent by email in August 2015, with up to two reminder emails spaced 2 weeks apart. Administrative staff at the CCA office sent most invitation emails to potential participants on behalf of the research team. The CCA has a contact database that comprises email addresses of each of the people we approached for participation. If this was not the case, e.g. representatives of the CMCC and UQTR, the lead author sent these invitation emails directly. The invitation emails contained information about participating in the study, outlined the consent procedure for participation (consent implied by completion of the survey), and a link to the online survey. We also raised awareness of the study by making a presentation at a meeting where key chiropractic profession stakeholder groups were present.
Delphi study procedure
The Delphi study consisted of three online surveys (created via the online platform FluidSurveys™, http://fluidsurveys.com/), and a face-to-face workshop. For each Delphi survey round, email invitations were followed up by two email reminders to non-responders.
In Round 1, participants were asked to suggest research areas that they considered important, and to provide a rationale for their suggestions, within each of the following broad research themes: 1) Basic science: studies investigating theories or mechanisms; 2) Clinical research: studies investigating patient outcomes; 3) Health systems and services research: Studies investigating access to health care, or the quality and cost of health care; 4) Social, cultural, environmental and population health research: studies investigating the health of the general population; and, 5) Other research areas.
Participants were asked to suggest research areas that they judged to be important, and important to the members of the organisation that they represented. If relevant, participants were asked to consult with the constituent members who they represented in order to determine which research priorities were important to them, e.g. practicing chiropractors who were members of their provincial association.
In each Delphi round, we asked participants to consider their suggestions based on priority criteria, adapted from a study undertaken in the United Kingdom physiotherapy profession [3]:
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Does the topic address a significant need or gap in the evidence for Canadian chiropractic practice and/or service delivery?
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What is the potential impact of the research for the quality of chiropractic care and the experience for patients, their caregivers, and members of the public?
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3.
What is the potential impact of the research for Canadian chiropractic practice?
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What is the potential impact of the research for: Canadian chiropractic profession decision-makers; third party payors including insurance companies, workers and motor vehicle accident compensation authorities; and, relevance to government policy and priorities?
Results from Round 1 of the survey were presented to some participants in a face-to-face facilitated workshop at the CCA National Convention in September 2015. All survey participants were invited to attend the workshop, and 28 individuals attended. Participants were presented the results of Round 1 of the Delphi survey. Small groups, containing representatives from each of the stakeholder groups listed above, discussed the Round 1 results facilitated by a member of the research team. The small group task included a discussion of whether the initial research areas identified were comprehensive, and whether they met the research priority criteria. Members of the small groups could also identify new research priority areas not already suggested. Facilitators ensured that all small group members were given an opportunity to contribute to the discussion. Following the discussion, the facilitator collated any new research ideas, and these were added to the list of ideas identified in Round 1 of the Delphi survey.
All research priority areas suggested by participants were then collated by theme and further categorised into sub-themes. Sub-themes from the Round 1 responses, and from the workshop, were generated independently by two authors (PJHB and PB), and then discussed with the lead author to achieve consensus.
In Round 2 of the Delphi survey, we presented all of the sub-themes and research ideas to the participants, along with stated rationales from Round 1. Participants were asked the question “How important is the following research area for the chiropractic profession in Canada?” and were asked to rate the importance of the sub-themes on a Likert scale (essential; very important; moderately important; slightly important; not at all important). Participants could also suggest new research ideas and sub-themes during Round 2, and these additional areas would be rated for importance in Round 3. Using the results of Round 2, we defined consensus as 70% of the participants agreeing that a research priority was “essential” or “very important”. Although there is no universally agreed proportion for consensus for Delphi studies, 70% consensus is a commonly used benchmark [18].
In Round 3, the results of Round 2 were provided to the participants showing each research sub-theme and the percentage results for sub-themes that reached, and did not reach, consensus. We asked participants to re-rate the importance of each research sub-theme, taking into consideration the panel members’ importance rating as a whole.
Prioritisation process
In the final survey round, all research priority areas that reached consensus in Round 3 were ranked by the participants via 1000Minds (1000Minds software, https://www.1000minds.com/) using conjoint analysis methodology [19]. Panel members were asked to rank pairwise statements by determining which of two randomly selected research sub-themes they considered more important for the Canadian chiropractic profession. The software eliminates other possible pairwise comparisons that have been implicitly ranked as corollaries of questions already answered, thus minimising the number of pairwise-ranking questions for each panel member. This was achieved by the ‘transitivity’ principle; for example, if a participant ranked sub-theme ‘A’ ahead of research area ‘B’ and also ‘B’ ahead of sub-theme ‘C’, then ‘A’ would be ranked ahead of ‘C’ and the software did not ask a question pertaining to this third pairwise ranking. Based on participants’ responses, 1000Minds uses mathematical methods (explained in detail in [19]) to arrive at overall rankings of the research sub-themes, both for each individual participant and also averaged across all participants. We present median and mean rank across all participants for each research sub-theme are presented.