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The Launch of the Institute of Musculoskeletal Health and Arthritis 2014-2018 Strategic Plan: Positive Implications for Canadian Chiropractors and their Patients.

In October 2014, in downtown Toronto, the Canadian Institutes of Health Research (CIHR) Institute of Musculoskeletal Health and Arthritis (IMHA) held a meeting called Science in Motion. The purpose of the meeting was to bring together IMHA stakeholders to discuss the implementation of IMHA’s Strategic Plan for 2014–18. One hundred and nine delegates were invited from over 17 universities, and 34 agencies, centres, networks, coalitions, societies, alliances, companies and institutes from across Canada, and around the world. According to the Director of IMHA, Dr. Hani El-Gabalawy, the responsibility of the invitees was to share their “wealth of assembled knowledge and experience to bear on the key challenge of operationalizing IMHA’s Strategic Plan”. It was exciting to see the chiropractic profession represented at such a pivotal event for health research in Canada. 
 
CIHR integrates research through an interdisciplinary structure made up of 13 institutes. CIHR’s Institutes are networks of researchers and research users brought together to focus on important health problems. IMHA is the most relevant institute for Canadian chiropractors. IMHA supports research to enhance active living, mobility and movement, and oral health. IMHA addresses causes, prevention, screening, diagnosis, treatment, support systems, and palliation for a wide range of conditions related to bones, joints, muscles, connective tissue, skin and teeth. The overall vision of IMHA is to lead musculoskeletal (MSK), skin and oral health research and knowledge translation to improve the lives of Canadians. In order to achieve their vision IMHA has three guiding research themes: 1) Capacity Building; 2) Innovation; and 3) Translation. 
 
 
 
 
 
The IMHA Strategic Plan for 2014–18 is titled “Enhancing Musculoskeletal, Skin and Oral Health” and has three priority investment areas: 1) Chronic Pain and Fatigue; 2) Inflammation and Tissue Repair; and 3) Disability, Mobility and Health. Four core values are at the heart of the strategic plan. They include: 1) Ethics; 2) Performance Measurement; 3) Evidence Informed Decision Making; and 4) Partnerships and Citizen Engagement. 
 
The meeting was chaired by Dr. Monique Gignac, the Chair of the IMHA Institute Advisory Board. Following the initial remarks and welcoming to the conference by Dr. Hani El-Gabalawy, a video was played to introduce the IMHA Strategic Plan, and the conference. In the video Chiropractic was acknowledged as one of the healthcare disciplines which manages the clinical needs of Canadians. IMHA was committed to ensuring that individual meeting delegates had a voice, and one of the ways to do this was setting up a twitter hash-tag. Delegates were able to provide feedback and comments throughout the day via the twitter hashtag “#IMHASIM.” 
 
The meeting then began with presentations addressing the research gaps that presently exist in the three priority areas. Gary Macfarlane, a Professor of Epidemiology at Aberdeen University in the United Kingdom (UK) spoke on the first strategic priority, Chronic Pain and Fatigue. He acknowledged that for arthritis research in the UK, musculoskeletal pain is being explored by both pharmacological and non-pharmacological approaches. He discussed the conduct of clinical trials and that it is imperative to know what outcome measures to apply a priori to ensure accurate findings. He also mentioned the STarT Back screening tool developed at Keele University. The STarT Back tool stratifies low back pain patients, rather than simply sending them all directly for surgical consultation. Similar initiatives are occurring in Canada and could present unique opportunities for the chiropractic profession. 
 
The next presentation addressed the second strategic priority Inflammation and Tissue Repair and was presented by Katherine Siminovitch, Director of the University Health Network’s Clinical Genomics Centre and Centre for Genetic Medicine in Toronto. She focused on the genetic involvement in the manifestation of pathological conditions, and epigenetics, which is the study of specific cell types whose protein synthesis is reversible and sensitive to the environment. Her vision is that future medications can focus on “druggable pathways” by using genetic screenings to determine which people will respond to specific drugs. She predicted that the future of pharmaceutical intervention on genetically modifiable diseases will be predictive, preventive and personalized. 
 
The final strategic priority presented on was Disability, Mobility and Health. Joy MacDermid a Professor in the School of Rehabilitation Science at McMaster University in Hamilton used a conceptual framework set out by the World Health Organization. She addressed how the severity of MSK disorders can impact mortality through sedentary behaviours that also leads to cardiovascular pathology. She acknowledged that injuries in the workforce related to trauma have gone down, but that the prevalence of MSK strain conditions has increased. She stressed that clinicians prescribing medications or physical activity need to be aware that adherence of patients to the recommended treatments is low. She stated that there is a need to consider alternative and innovative care delivery models, and that researchers need to study dosages of such interventions. 
 
 
Next, meeting participants were divided into small groups to discuss the implementation of the strategic plan. Groups were asked to consider three specific questions for three 15-minute discussions as a group: 
 
 
What are your suggestions for how the IMHA-specific strategic funding should be allocated within your assigned strategic priority area? Which programs/tools should be used? 
 
 
What are the cross-cutting themes within the IMHA strategic priority area you were assigned that would allow IMHA to align itself with other multi-institute initiatives? 
 
 
What would be the best way(s) for IMHA’s stakeholder communities to have on-going input into shaping both the IMHA-specific and the CIHR multi-institute strategic initiatives? 
 
 
 
Each group had a Rapporteur who summarized the discussions, and after consensus from the small group, reported back to the entire conference delegation.