Outcome Assessment

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.

©2010 Cleveland Chiropractic College –
Kansas City and Los Angeles

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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Chiropractic Management for Veterans with Neck Pain: A Retrospective Study of Clinical Outcomes

By Frank M. Painter|September 27, 2011|Outcome Assessment, Veterans|

Chiropractic Management for Veterans with Neck Pain:
A Retrospective Study of Clinical Outcomes

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2011 (Oct); 34 (8): 533–538

Andrew S. Dunn, DC, MEd, MS, Bart N. Green, DC, MSEd, Lance R. Formolo, DC, MS, David R. Chicoine

Chiropractic Department, Medical Care Line, VA Western New York, Buffalo, NY, USA. andrew.dunn@va.gov

OBJECTIVE: The purpose of this study was to report demographic characteristics, chiropractic treatment methods and frequency, and clinical outcomes for chiropractic management of neck pain in a sample of veteran patients.

METHODS: This is a retrospective case series of 54 veterans with a chief complaint of neck pain who received chiropractic care through a Veterans Health Administration medical center. Descriptive statistics and paired t tests were used with the numeric rating scale and Neck Bournemouth Questionnaire serving as the outcome measures. A minimum clinically important difference was set as 30% improvement from baseline for both outcomes. (more…)

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A Critical Piece of Quality Documentation: Outcomes Assessment

By Frank M. Painter|May 25, 2011|Documentation, Outcome Assessment|

A Critical Piece of Quality Documentation: Outcomes Assessment

The Chiro.Org Blog

SOURCE: American Chiropractor 2011 (May) 33 (5): 28-34

by Steven Yeomans, D.C.

Today more than ever, chiropractors are faced with the challenge of running a busy practice and, at the same time, juggling the documenting requirements in light of Medicare audits, proving “medical necessity” to private insurers, and producing documentation that minimizes risk in this litigious world. The requirement of creating a legible, concise account of the patient encounter that includes patient centered functional goals and methods of tracking functional improvements that occur during care, emphasizes the need for the inclusion of outcomes assessment tools in the documentation process. The goal of this article is to provide you with the “knowledge ammunition” needed to accomplish this task without expending volumes of time and effort.

Outcomes assessment tool availability is not a new concept. Back in the 1970’s, long, impractical outcomes tools surfaced that were too cumbersome for routine use in a primary care setting, but shortly thereafter, in 1980, Fairbank introduced the Oswestry (Low Back) Disability Index (ODI). An interesting point is that the original purpose of the ODI was to identify patients that may require “…positive intervention” in the form of psychological care when scores exceeded 60% (defined as “crippled”).

However, it was (also) found to be an effective tool to be used in serial manner to show patient progress over time and identify endpoints of care or plateaus in progress, prompting a change in the treatment planning for the patient. This was followed by other “gold standard” tools including the Roland-Morris Low Back Disability Questionnaire in 1984, and the chiropractic contribution of Vernon and Mior’s Neck Disability Index in 1988.

A gradual increase in the use of these tools occurred in the 1990’s with introduction of many other condition specific tools for headaches, dizziness, carpal tunnel, shoulder pain, hip, knee, and ankle pain, as well as general health tools, and psychometric tools for depression and anxiety assessment. In fact, there are now so many tools available, it may be quite a challenge to decide which ones are most important. (more…)

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The RAND 36-Item Health Survey 1.0 (SF 36)

By Frank M. Painter|August 25, 2009|Documentation, Education, Outcome Assessment|

The RAND 36-Item Health Survey 1.0 (SF 36)

The Chiro.Org Blog

SOURCE: Chiro.Org’s Outcome Assessment Questionnaire Page

Patient self-perception of the health care experience is becoming an important component of clinical outcomes assessment. In light of the progression toward a more closely managed health care system, chiropractors are being expected to document and quantify clinical progress. Functional health status instruments are an economical & efficient way of accomplishing that task. [1]

The RAND Health Survey measures physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, sense of emotional well-being, energy/fatigue levels, pain, general health perception, and health change. These questions focus on areas of clinical complaint that many patients are experiencing upon presentation to the chiropractic office. (more…)

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Do You Use Outcome Assessment Questionnaires?

By Frank M. Painter|August 16, 2009|Education, Outcome Assessment|

Do You Use Outcome Assessment Questionnaires?

The Chiro.Org Blog

If you haven’t noticed lately, every provider in each discipline is being held accountable for the care they provide to a patient. Why? Because evidence–based treatment approaches are becoming an expected “standard” for proving the effectiveness of care over time, and because tracking outcomes is a means by which insurers decide if the care provided has been necessary.

The Outcome Assessment Page contains, or links to, most of the best-supported OA questionnaires. It also has a collection of articles about the use of OA in the field.

You may find the Outcome Assessment Guidelines Section of interest.

That page is one of many of the useful tools found in the
Clinical Documentation Section.

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Predicting Immediate Improvement With Cervical Spine Adjusting

By Frank M. Painter|July 28, 2009|Education, Outcome Assessment|

Patients with nonspecific musculoskeletal disorders may vary in their responses to treatment. For that reason, a recent, large prospective study in JMPT set out to identify the predictors for improvement or worsening of symptoms when cervical spine manipulation was indicated.

Data was collected from 28,807 treatment consultations (19,722 patients) and 13,873 follow-up treatments. The presenting symptoms of “neck pain”, “shoulder, arm pain”, “reduced neck, shoulder, arm movement, or stiffness”, “headache”, and “upper, mid back pain” all emerged in the final model as significant predictors for immediate improvement. The presence of any 4 of these predictors raised the probability of an immediate improvement in presenting symptoms after treatment from 70% to approximately 95%. (more…)

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