Frank M. Painter

Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

By Frank M. Painter|March 15, 2012|Chiropractic Care, Clinical Decision-making, Diagnosis, Education|

Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

SOURCE: Chiropractic & Manual Therapies 2012 (Mar 14); 20: 6

Lyndon G Amorin-Woods and Gregory F Parkin-Smith

Murdoch University, School of Chiropractic and Sports Science, South Street, Murdoch, 6150 Perth, Western Australia. L.Woods@murdoch.edu.au

Background: A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.

Discussion: This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called ‘3-Questions Model’;

Summary: Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

From the FULL TEXT Article:

Development of the 3-questions Model

The chiropractic profession, particularly in Western countries, finds itself in a rapidly evolving healthcare landscape, with ‘modernisation’ being a consequence of escalating costs, an aging population, and an ever-diminishing relative resource base [9]. With a view to rationalising resources health system decision-makers are increasingly vigilant about the delivery of safe, evidence-based, cost-effective care, summarised as “the right care at the right time in the right place” [10, 11]. With this imperative in mind, the authors propose three straightforward questions that frame clinical decision-making within the context of diagnostic uncertainty.

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Wilk v. AMA 25 Years Later: Why It Still Isn’t Over

By Frank M. Painter|March 13, 2012|News|

Wilk v. AMA 25 Years Later: Why It Still Isn’t Over

The Chiro.Org Blog

SOURCE: ACA News ~ March 2012

By Lori A. Burkhart

The future of the chiropractic profession changed on Aug. 27, 1987, when federal court judge Susan Getzendanner found the American Medical Association (AMA) guilty of conspiring to destroy chiropractic. [1]

Early History

The nefarious plot was hatched in 1962 when the Iowa Plan was adopted by the Iowa Medical Society with the goal of eradicating chiropractic in that state. The Iowa Plan is summed up in the plaintiffs’ 132-page aid to the court, submitted June 25, 1987, in the Wilk case.

The Iowa Plan’s section “What Medicine Should Do About The Chiropractic Menace” includes a Part G titled “Undertake a positive program of ‘containment’” in which an often quoted phrase in chiropractic literature can be found: “If this program is successfully pursued, it is entirely likely that chiropractic as a profession will ‘wither on the vine’ and the chiropractic menace will die a natural but somewhat undramatic death. This policy of ‘containment’ might well be pursued along the following lines:

Encourage ethical complaints against doctors of chiropractic;
Oppose chiropractic inroads in health insurance;
Oppose chiropractic inroads in workmen’s compensation;
Oppose chiropractic inroads into labor unions;
Oppose chiropractic inroads into hospitals; and
Contain chiropractic schools.

The Iowa Plan states that such actions taken by the medical profession should be persistent and behind-the-scenes whenever possible. The medical community should never give professional recognition to doctors of chiropractic (DCs), and thus a successful program of containment will result in the decline of chiropractic.

In Wilk v. AMA, Judge Getzendanner explains that the AMA hired as its general counsel Robert B. Throckmorton, the author of the Iowa Plan, and that “as early as September 1963, the AMA’s objective was the complete elimination of the chiropractic profession.” Two months later, the AMA formed the Committee on Quackery under its Department of Investigation (DOI), and by 1964 its goal was to do away with chiropractic throughout the United States.

You may also want to review the original:

Wilk, et al vs. the AMA, et al case

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Cerebral Perfusion in Patients with Chronic Neck and Upper Back Pain: Preliminary Observations

By Frank M. Painter|March 3, 2012|Spinal Manipulation, Subluxation|

Cerebral Perfusion in Patients with Chronic Neck and Upper Back Pain: Preliminary Observations

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2012 (Feb); 35 (2): 76-85

Maxim A. Bakhtadze, MD, PhD, Howard Vernon, DC, PhD, Anatoliy V. Karalkin, MD, PhD, Sergey P. Pasha, MD, PhD, Igor O. Tomashevskiy, MD, PhD, David Soave, MS

Center for Manual Therapy, Moscow, Russia.

OBJECTIVE: The purpose of this study was to determine the correlation between cerebral perfusion levels, Neck Disability Index (NDI) scores, and spinal joint fixations in patients with neck pain.

METHODS: Forty-five adult patients (29 were female) with chronic neck/upper thoracic pain during exacerbation were studied. The subjects were grouped according to NDI scores: mild, moderate, and severe. The number of painful/blocked segments in the cervical and upper thoracic spine and costovertebral joints, pain intensity using the visual analog scale, and regional cerebral blood flow of the brain using single-photon emission computed tomography (SPECT) were obtained. The SPECT was analyzed semi-quantitatively. Analysis of variance tests were conducted on total SPECT scores in each of the NDI groups (P < .05). Univariate correlations were obtained between blockage, pain, and SPECT scores, as well as age and duration. A multivariate analysis was then conducted.

RESULTS: Group 1 (mild) consisted of 14 patients. Cerebral perfusion measured by SPECT was normal in all 8 brain regions.

Group 2 (moderate) consisted of 16 patients. In this group, a decrease in cerebral perfusion was observed (range, 20%-35%), predominantly in the parietal and frontal zones. (more…)

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Cerebral Metabolic Changes in Men After Chiropractic Spinal Manipulation for Neck Pain

By Frank M. Painter|March 2, 2012|Spinal Manipulation, Stress Reduction|

Cerebral Metabolic Changes in Men After Chiropractic
Spinal Manipulation for Neck Pain

The Chiro.Org Blog

SOURCE: Altern Ther Health Med. 2011 (Nov); 17 (6): 12-17

Takeshi Ogura, DC, PhD; Manabu Tashiro, MD, PhD;
Mehedi Masud, MD, PhD; Shoichi Watanuki et. al

Division of Cyclotron Nuclear Medicine,
Tohoku University, Sendai, Japan.

Background: Chiropractic spinal manipulation (CSM) is an alternative treatment for back pain. The autonomic nervous system is often involved in spinal dysfunction. Although studies on the effects of CSM have been performed, no chiropractic study has examined regional cerebral metabolism using positron emission tomography (PET).

Objective: The aim of the present study was to investigate the effects of CSM on brain responses in terms of cerebral glucose metabolic changes measured by [18F]fluorodeoxyglucose positron emission tomography (FDG-PET).

Methods: Twelve male volunteers were recruited. Brain PET scanning was performed twice on each participant, at resting and after CSM. Questionnaires were used for subjective evaluations. A visual analogue scale (VAS) was rated by participants before and after chiropractic treatment, and muscle tone and salivary amylase were measured.

(more…)

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The Role of Chiropractic Care in Older Adults

By Frank M. Painter|February 26, 2012|Chiropractic Care, Health Care Reform, Research, Spinal Manipulation|

The Role of Chiropractic Care in Older Adults

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Feb 21), 20: 3

Paul E Dougherty, Cheryl Hawk, Debra K Weiner,
Brian Gleberzon, Kari Andrew, Lisa Killinger

There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

Introduction:

By 2030, nearly one in five U.S. residents is expected to be age 65 or older [1]. An estimated 14% of patients treated by doctors of chiropractic (DCs) are 65 and older [2]. The most common reason for an older adult to see a DC is musculoskeletal pain, most often lower back pain [3]. Although the most common reason for older adults seeking chiropractic care is for musculoskeletal symptoms, DCs may also provide a diverse range of services to these patients [4] .Given this fact, for the purpose of this manuscript chiropractic care will be defined as; “the provision by a doctor of chiropractic of services related to patient assessment, maintenance of health, prevention of illness, and treatment of illness or injury.” The focus of this manuscript is to describe the evidence for achievement of some of these goals in the older adult population. The purpose of this manuscript is to present an overview of information to the practicing chiropractor on utilization of specific management tools. This is not meant to be a systematic review of the literature or an evidence based guideline. The authors each have personal experience in evaluating and treating older adults as well as established expertise in research and publication in these areas. The authors recognize that there is a need for further research in the area of management of the older adult by DC’s and discuss in the conclusion future research considerations. (more…)

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Chiropractic Research & Practice: State of the Art

By Frank M. Painter|February 24, 2012|Cost-Effectiveness, Evidence-based Medicine, Health Care Reform, Outcome Assessment, Patient Satisfaction, Prevention, Public Health, Research, Spinal Manipulation, Wellness Care|

Chiropractic Research & Practice State of the Art

The Chiro.Org Blog

SOURCE: Cleveland Chiropractic College

By Daniel Redwood, D.C., professor,
Cleveland Chiropractic College

Peer Reviewers: Carl S. Cleveland III, D.C., J.
Michael Flynn, D.C., Cheryl Hawk, D.C., PhD., and
Anthony Rosner, PhD.

Chiropractic Research & Practice

State of the Art

Since chiropractic’s breakthrough decade in the 1970s — when the U.S. federal government included chiropractic services in Medicare and federal workers’ compensation coverage, approved the Council on Chiropractic Education (CCE) as the accrediting body for chiropractic colleges, and sponsored a National Institutes of Health (NIH) conference on the research status of spinal manipulation — the profession has grown and matured into an essential part of the nation’s healthcare system.

Chiropractic was born in the United States in the late 19th century and the U.S. is home to approximately 65,000 of the world’s 90,000 chiropractors. [1] The chiropractic profession is the third largest independent health profession in the Western world, after medicine and dentistry. Doctors of chiropractic are licensed throughout the English-speaking world and in many other nations as primary contact providers, licensed for both diagnosis and treatment without medical referral. In 2005, the World Health Organization (WHO) published WHO Guidelines on Basic Training and Safety in Chiropractic, which documented the status of chiropractic education and practice worldwide and sought to ensure high standards in nations where chiropractic is in the early stages of development. [2]

Rigorous educational standards are supervised by government-recognized accrediting agencies in many nations, including CCE in the United States. After fulfilling college science prerequisites similar to those required to enter medical schools, chiropractic students must complete a chiropractic college program of four academic years, which includes a wide range of courses in anatomy, physiology, pathology, and diagnosis, as well as spinal adjusting, physiotherapy, rehabilitation, public health and nutrition. (more…)

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About Frank M. Painter

Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

Wilk v. AMA 25 Years Later: Why It Still Isn’t Over

Wilk v. AMA 25 Years Later: Why It Still Isn’t Over

Cerebral Perfusion in Patients with Chronic Neck and Upper Back Pain: Preliminary Observations

Cerebral Perfusion in Patients with Chronic Neck and Upper Back Pain: Preliminary Observations

Cerebral Metabolic Changes in Men After Chiropractic Spinal Manipulation for Neck Pain

Cerebral Metabolic Changes in Men After Chiropractic Spinal Manipulation for Neck Pain

The Role of Chiropractic Care in Older Adults

The Role of Chiropractic Care in Older Adults

Chiropractic Research & Practice: State of the Art

Chiropractic Research & Practice State of the Art

Cerebral Metabolic Changes in Men After Chiropractic
Spinal Manipulation for Neck Pain