Part 8 of 9: Rethinking Research: Why Chiropractic and Physical Therapy Need a New Data Strategy

Why the Evidence Isn’t Enough

Despite delivering high-value care that consistently outperforms many traditional pathways for musculoskeletal conditions, chiropractic and physical therapy remain marginalized in medical networks, payer contracts, and referral streams. One might assume this is due to a lack of research—but that’s not quite the case.

Both professions have participated in decades of research, including hundreds of randomized controlled trials (RCTs). These studies have consistently shown that chiropractic and physical therapy offer moderate efficacy for spine-related pain conditions—results comparable to, or better than, many pharmacologic or surgical alternatives.

Yet despite this, the impact of RCT-based evidence on professional positioning, reimbursement, and public perception has been limited. Why? Because RCTs, while useful in controlled settings, are ill-equipped to capture the full scope of healing—particularly the kind that chiropractic and physical therapy deliver.

RCTs: Gold Standard or Lead Weight?

RCTs were designed to isolate a single variable and measure its effect. But healing—especially for pain—is rarely the result of a single input. It’s a complex, biopsychosocial process shaped by:

• Clinical input

• Emotional environment

• Therapeutic alliance

• Provider communication

• Expectations, beliefs, and meaning-making

Chiropractors and physical therapists do not deliver sterile, proceduralized care. They deliver care within a relationship, often involving repeated contact, personalized attention, and the co-creation of a care journey. These are factors that RCTs are not designed to measure—nor control for.

The Neuroscience of Healing: Why Experience Matters

Neuroscience has advanced our understanding of pain far beyond the “tissue damage” model. Today, we know that:

• The amygdala and limbic system regulate how pain is experienced.

• Emotional safety, predictability, and interpersonal connection can turn down the pain “rheostat.”

• The experience surrounding care—the sights, sounds, tone of voice, trust, and empathy—modulates the brain’s interpretation of pain and healing.

In this context, the provider is not just delivering a treatment—they’re creating an experience that affects how the nervous system interprets threat and recovery.

Chiropractic and physical therapy excel here. Independent clinics, community roots, and the intimate, high-touch nature of care create an environment tailored to human healing.

Why Traditional Research Is Not the Answer

Despite decades of solid clinical results, chiropractic and physical therapy continue to struggle with systemic positioning. This is because:

• RCTs flatten the clinical experience into variables that are easy to control but unrepresentative of reality.

• Claims-based research, often used by payers and intermediaries, only captures billing codes—not communication, experience, outcomes, or care quality. Additionally, as discussed in Episode 2, a meaningful contingent of patients shift from insurance coverage to cash within a single episode, resulting in flawed data and incorrect conclusions.

• Value signals are distorted: For example, a claim that includes only spinal manipulation tells little about what actually happened in the visit.

These forms of research have done little to help the professions position themselves effectively in value-based care or contracting discussions.

The Future: Practice-Based Research in Clinically Integrated Networks

The path forward is to lean heavily on practice-based research, built on real-world clinical data. This means:

• High-integrity EHR data that includes visit documentation, care plans, messaging, and outcomes.

• Patient-reported outcomes integrated into the care journey.

• Provider-level behavior and variation analysis that identifies high-value patterns.

• Experience data (e.g., NPS, satisfaction, continuity) that reflects the full spectrum of care.

Imagine a network like Arete, a clinically integrated network (CIN), using EHR integrations and shared data architecture to:

• Track care across thousands of providers in real time,

• Surface patterns of success,

• Compare access, resolution rates, and patient experiences across care models,

• Publish insights not just on what works—but how it works, for whom, and under what conditions.

This is not theoretical. Arete Network is already doing this for chiropractic and physical therapy.

Why This Matters: A Solution for the Professions

Practice-based research, conducted through a clinically integrated network, offers:

• A counterweight to claims-based misrepresentation,

• A replacement for flat-effect RCT data, and

• A tool to elevate the profession with health systems, employers, and payers.

It enables chiropractors and physical therapists to:

• Show not just that care works, but how outcomes are shaped by the provider-patient relationship,

• Track scope-of-practice usage and how it correlates to patient satisfaction, resolution, and costs,

• Demonstrate leadership in access, experience, and conservative care pathways.

In short: this is the data strategy the professions must invest in. It is the path to improved reimbursement, better positioning, and long-term relevance in a value-based world.

Conclusion: From Research Subject to Research Leader

Chiropractic and physical therapy have spent decades waiting for RCTs and external researchers to validate their value and position these high value disciplines as preferred portal of entry for MSK presentations. But that strategy has failed to shift the system.

Now it’s time to lead.

• Organize data at scale.

• Build research from practice—not theory.

• Tell the full story of healing—not just the variables that fit a spreadsheet.

Clinically integrated networks like Arete are not just an operational model—they are a research and advocacy engine. If the professions invest in this future, they can finally move from being studied to shaping the evidence that drives healthcare transformation.