Guidelines

Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain

By Frank M. Painter|September 3, 2011|Guidelines, Neck Pain, Spinal Manipulation|

Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain

SOURCE: Chiropractic & Manual Therapies 2011 (Aug 27)

Donald R Murphy, DC, DACAN, and
Eric L Hurwitz, DC, PhD

Background: Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP.

Methods: Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG.

Results: Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%.

Conclusion: The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as interexaminer reliability, validity and efficacy of treatment based on the DBCDG.

The FULL TEXT Article

BACKGROUND

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page and the

A Clinical Model for the Diagnosis and Management Page

(more…)

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Chiropractic Goes To The Hospital

By Frank M. Painter|March 6, 2011|Evidence-based Medicine, Guidelines, Low Back Pain|

Chiropractic Goes To The Hospital

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2011 (Feb); 34 (2): 98–106

Paskowski I, Schneider M, Stevans J, Ventura JM, Justice BD.

Medical Back Pain Program,
Jordan Hospital,
Plymouth, Mass

This hospital-based study is interesting for several reasons:

First, they utilized an evidence-based program for treating low back pain (LBP)
Based on that evidence, they assigned 83% of those who sought care to chiropractic management.
Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, and
95% of those patients rated their care as “excellent.”

OBJECTIVE: A health care facility (Jordan Hospital) implemented a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. The purpose of this report is to describe the implementation and results of a multidisciplinary, evidence-based, standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.

METHODS: A standardized SCP was developed to improve the quality of back pain care. The NCQA BPRP provided the framework for the SCP to determine the standard of quality care delivered. Patients were triaged, and suitable patients were categorized into 1 of 5 classifications based upon history and examination, directional exercise flexion or “extension biases,” spinal manipulation, traction, or spinal stabilization exercises.

RESULTS: The findings for 518 consecutive patients were included. One hundred sixteen patients (10%) were seen once and triaged to specialty care; 7% of patients received magnetic resonance imagings. Four hundred thirty-two patients (83%) were classified and treated by doctors of chiropractic and/or physical therapists. Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, mean intake pain rating score of 6.2 of 10, and mean discharge score of 1.9 of 10; 95% of patients rated their care as “excellent.” (more…)

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Chiropractic Associations Describe Chiropractic Care Using Conventional Terminology

By John Wiens DC|September 16, 2010|Guidelines|

Source The American Chiropractic Association

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP), with assistance from the American Chiropractic Association (ACA), has established terminology that describes chiropractic care using conventionally recognized terminology across the accepted continuum of care. The terminology was established by a formal consensus process conducted in early 2009.

The chiropractic profession is making great strides with integration among health care providers and insurers. Doctors of chiropractic now practice in many military and Department of Veterans Affairs (VA) sites, in hospital settings and in a variety of integrated practice models. As our nation’s health care landscape changes and the primary care shortage becomes more acute, the stage will be set for even more integration of doctors of chiropractic among other health care providers—traditional and alternative. Therefore, it is vital that the scope of appropriate chiropractic care be clearly defined relative to overall patient case management. (more…)

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The Council on Chiropractic Education Accreditation Standards Draft for 2012

By John Wiens DC|September 14, 2010|Guidelines|

In the 2012 draft of the Council on Chiropractic Education’s Accreditation Standards one of the bullet points in their mission statement reads, “Serving as a unifying body for the chiropractic profession.”

In a September 1st, 2010 document to interested parties on the Life West Chiropractic College website titled “A discussion of a limited number of changes in the CCE’s 2007 version of the Standards for Doctor of Chiropractic programs and proposed revisions to the same”, college president Dr. Gerald Clum seems to disagree with that statement. He summarizes his concerns thusly,

Concern: The items outlined above indicate an attempt to move the profession:

Toward the Doctor of Chiropractic Medicine perspective

Away from any use of the term subluxation

Toward the inclusion of drug therapy

Away from being a drugless discipline

Toward a generalized common definition of primary care as used in primary care medicine

Away from any definition of chiropractic and what a chiropractor does

And so, the thorny issue of unity never goes away. Do we move forward into a world that knows only “chiropractic medicine” or do we maintain that chiropractic is and always should be “separate and distinct”? Or, can we have it both ways? One thing is sure. If we continue to confound the public as to our identity we will never see the numbers of patients to which we believe we are entitled.

Relevant documents…

CCE home page

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European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain in Primary Care

By Frank M. Painter|June 25, 2010|Guidelines, Low Back Pain, News, Unnecessary Surgery|

European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain in Primary Care

The Chiro.Org Blog

You will enjoy these recent European evidence-based guidelines for the management of acute and chronic low back pain.

Both the Acute Back Pain Guideline and the
Chronic Back Pain Guideline recommend spinal manipulation
as an effective conservative treatment.

Interestingly, MOST of what’s considered “standard medical treatment” are listed as
Invasive treatments, that should NOT be recommended for non-specific CLBP.

Non-recommended medical treatments include:

Bed rest,

Acupuncture,

intradiscal injections,

epidural corticosteroid injections,

intra-articular (facet) steroid injections,

local facet nerve blocks,

trigger point injections,

prolotherapy,

botulinum toxin,

radiofrequency facet denervation,

intradiscal radiofrequency lesioning,

intradiscal electrothermal therapy,

radiofrequency lesioning of the dorsal root ganglion,

and spinal cord stimulation

(more…)

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Spine Task Force Neck Pain Evidence Summary

By Frank M. Painter|June 19, 2010|Guidelines, News|

Spine Task Force Neck Pain Evidence Summary

The Chiro.Org Blog

Toronto, June 18, 2010 – A new neck pain guide offers a concise summary on both helpful and unhelpful approaches to treating Neck Pain, based on the evidence synthesis completed by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain. IWH worked with the Canadian Memorial Chiropractic College, the Ontario Chiropractic Association and some members of the task force’s executive committee to prepare the summary.

In February 2008, Spine published a special edition dedicated to the task force’s reviews on the prevention, prognosis, diagnosis and management of neck pain. After publication, a network of Canadian chiropractic opinion leaders, coordinated by IWH, suggested distilling the evidence into a summary. “It’s exciting to see the chiropractic community take up the work of the task force this way,” says Dr. Sheilah Hogg-Johnson, a task force member and IWH senior scientist. “The Neck Pain Evidence Summary provides a way for health-care professionals to review the evidence easily in their practice, and if they need further information, they can refer to the full research papers.”The task force recommends treatments or further assessments, based on the severity of neck pain. They classified severity into four grades. In the Evidence Summary, a chart outlines the signs and symptoms, and further assessments for each grade. Then both helpful and unhelpful treatments are presented by grade and type of injury. (more…)

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