Evidence-Based Practice and Chiropractic Care
Ron LeFebvre, MA, DC, David Peterson, DC, and Mitchell Haas, MA, DC
University of Western States,
Portland, OR, USA.
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.
The use of complementary and alternative medicine has increased dramatically during the past several decades. [1, 2] Estimates based on the 2002 National Health Interview Survey reveal that 62.1% of US adults used complementary and alternative medicine therapies during the previous year.  Chiropractic is the largest complementary and alternative medicine profession in the United States, with approximately 70 000 members,  and chiropractic services account for the greatest number of complementary and alternative medicine visits.  In 2002, approximately 7.4% of Americans consulted a chiropractor for treatment.  Chiropractic is a well-established part of the health care delivery system, included under Medicare and Medicaid laws, with worker’s compensation coverage in all 50 states. Insurance coverage for chiropractic is also quite extensive. Approximately 50% of health maintenance organizations and 75% of private health insurance plans cover chiropractic care.
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