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Can Chiropractors Contribute to Work Disability Prevention Through Sickness Absence Management for Musculoskeletal Disorders?

By |January 20, 2019|Chiropractic Care, Return To Work, Workers' Compensation|

Can Chiropractors Contribute to Work Disability Prevention Through Sickness Absence Management for Musculoskeletal Disorders? – A Comparative Qualitative Case Study in the Scandinavian Context

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SOURCE:   Chiropractic & Manual Therapies 2018 (Apr 26); 26: 15

Mette Jensen Stochkendahl, Ole Kristoffer Larsen, Casper Glissmann Nim, Iben Axén, Julia Haraldsson, Ole Christian Kvammen, and Corrie Myburgh

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230
Odense M, Denmark.



BACKGROUND:   Despite extensive publication of clinical guidelines on how to manage musculoskeletal pain and back pain in particular, these efforts have not significantly translated into decreases in work disability due to musculoskeletal pain. Previous studies have indicated a potential for better outcomes by formalized, early referral to allied healthcare providers familiar with occupational health issues. Instances where allied healthcare providers of comparable professional characteristics, but with differing practice parameters, can highlight important social and organisational strategies useful for informing policy and practice. Currently, Norwegian chiropractors have legislated sickness certification rights, whereas their Danish and Swedish counterparts do not. Against the backdrop of legislative variation, we described, compared and contrasted the views and experiences of Scandinavian chiropractors engaging in work disability prevention and sickness absence management.

METHODS:   This study was embedded in a two-phased, sequential exploratory mixed-methods design. In a comparative qualitative case study design, we explored the experience of chiropractors regarding sickness absence management drawn from face-to-face, semi-structured interviews. We subsequently coded and thematically restructured their experiences and perceptions.

RESULTS:   Twelve interviews were conducted. Thematically, chiropractors’ capacity to support patients in sickness absence management revolved around four key issues: issues of legislation and politics; the rationale for being a sickness absence management partner; whether an integrated sickness absence management pathway existed/could be created; and finally, the barriers to service provision for sickness absence management.

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Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers

By |January 17, 2019|Chiropractic Care|

Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers

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SOURCE:   JAMA Netw Open. 2018 (Oct 5); 1 (6): e183044

James Heyward, MPH; Christopher M. Jones, PharmD, MPH; Wilson M. Compton, MD, MPE; et al

Center for Drug Safety and Effectiveness,
Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland.



IMPORTANCE:   Despite epidemic rates of addiction and death from prescription opioids in the United States, suggesting the importance of providing alternatives to opioids in the treatment of pain, little is known regarding how payers’ coverage policies may facilitate or impede access to such treatments.

OBJECTIVE:   To examine coverage policies for 5 nonpharmacologic approaches commonly used to treat acute or chronic low back pain among commercial and Medicare Advantage insurance plans, plus an additional 6 treatments among Medicaid plans.

DESIGN, SETTING, AND PARTICIPANTS:   Cross-sectional study of 15 commercial, 15 Medicaid, and 15 Medicare Advantage health plans for the 2017 calendar year in 16 states representing more than half of the US population. Interviews were conducted with 43 senior medical and pharmacy health plan executives from representative plans.

MAIN OUTCOMES AND MEASURES:   Medical necessity and coverage status for the treatments examined, as well as the use of utilization management tools and cost-sharing magnitude and structure.

RESULTS:   Commercial and Medicare insurers consistently regarded physical and occupational therapy as medically necessary, but policies varied for other therapies examined.

Payers most commonly covered

physical therapy (98% [44 of 45 plans]),

occupational therapy (96% [43 of 45 plans]), and

chiropractic care (89% [40 of 45 plans]),

while transcutaneous electrical nerve stimulation (67% [10 of 15 plans]) and steroid injections (60% [9 of 15 plans]) were the most commonly covered among the therapies examined for Medicaid plans only.

Despite evidence in the literature to support use of acupuncture and psychological interventions, these therapies were either not covered by plans examined (67% of all plans [30 of 45] did not cover acupuncture) or lacked information about coverage (80% of Medicaid plans [12 of 15] lacked information about coverage of psychological interventions). Utilization management tools, such as prior authorization, were common, but criteria varied greatly with respect to which conditions and what quantity and duration of services were covered. Interviewees represented 6 Medicaid managed care organizations, 2 Medicare Advantage or Part D plans, 9 commercial plans, and 3 trade organizations (eg, Blue Cross Blue Shield Association). Interviews with plan executives indicated a low level of integration between the coverage decision-making processes for pharmacologic and nonpharmacologic therapies for chronic pain.

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Epidemiology: Spinal Manipulation Utilization

By |May 22, 2018|Chiropractic Care|

Epidemiology:
Spinal Manipulation Utilization

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SOURCE:   J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 648–654

Eric L. Hurwitz

Department of Public Health Sciences,
John A. Burns School of Medicine,
University of Hawaii,
M?noa, Honolulu, HI 96822, USA.


The objectives of this article are to

(1)   describe spinal manipulation use by time, place, and person, and

(2)   identify predictors of the use of spinal manipulation.

We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world. In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies.

Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.


From the Full-Text Article:

Introduction

Although spinal manipulation has been practiced for thousands of years in several cultures spanning the globe, it is most commonly associated with chiropractic and osteopathy, which originated in the late 1800s in the United States (Pettman, 2007). The purpose of this article is to review the literature on the use of spinal manipulation. Specifically, our objectives are twofold: (1) To describe spinal manipulation use by time (temporal trends), place (geographic distribution), and person (practitioner and patient), and (2) to identify predictors of the use of spinal manipulation.

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Patients Receiving Chiropractic Care in a Neurorehabilitation Hospital

By |May 18, 2018|Chiropractic Care|

Patients Receiving Chiropractic Care in a Neurorehabilitation Hospital: A Descriptive Study

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SOURCE:   J Multidiscip Healthc. 2018 (May 3); 11: 223–231

Robert D Vining, Stacie A Salsbury, W Carl Cooley, Donna Gosselin, Lance Corber, and Christine M Goertz

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA, USA.


OBJECTIVES:   Individuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions.

DESIGN:   Chiropractic services were integrated into Crotched Mountain Specialty Hospital (CMSH) through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available.

SETTING:   CMSH, a 62–bed subacute multidisciplinary rehabilitation, skilled nursing facility located in Greenfield, New Hampshire, USA.

RESULTS:   Patient mean (SD) age (n=27) was 42.8 (13) years, ranging from 20 to 64 years. Males (n=18, 67%) and those of white race/ethnicity (n=23, 85%) comprised the majority. Brain injury (n=20) was the most common admitting condition caused by trauma (n=9), hemorrhage (n=7), infarction (n=2), and general anoxia (n=2). Three patients were admitted for cervical SCI, 1 for ankylosing spondylitis, 1 for traumatic polyarthropathy, and 2 for respiratory failure with encephalopathy. Other common comorbid diagnoses potentially complicating the treatment and recovery process included myospasm (n=13), depression (n=11), anxiety (n=10), dysphagia (n=8), substance abuse (n=8), and candidiasis (n=7). Chiropractic procedures employed, by visit (n=641), included manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address patients with spinal-related pain (n=15, 54%), joint or regional stiffness (n= 14, 50%), and extremity pain (n=13, 46%). Care often required adapting to participant limitations or conditions. Such adaptations not commonly encountered in outpatient settings where chiropractic care is usually delivered included the need for lift assistance, wheelchair dependence, contractures, impaired speech, quadriplegia/paraplegia, and the presence of feeding tubes and urinary catheters.

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Nontraditional Therapies (Traditional Chinese Veterinary Medicine and Chiropractic) in Exotic Animals

By |April 22, 2018|Acupuncture, Chiropractic Care|

Nontraditional Therapies (Traditional Chinese Veterinary Medicine and Chiropractic) in Exotic Animals

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SOURCE:   Vet Clin North Am Exot Anim Pract. 2018 (May); 21 (2): 511–528

Jessica A. Marziani, DVM, CVA, CVC, CCRT

CARE Veterinary Services PLLC,
PO Box 132082, Houston, TX 77219, USA


The nontraditional therapies of Traditional Chinese Veterinary Medicine and chiropractic care are adjunct treatments that can be used in conjunction with more conventional therapies to treat a variety of medical conditions. Nontraditional therapies do not need to be alternatives to Western medicine but, instead, can be used simultaneously. Exotic animal practitioners should have a basic understanding of nontraditional therapies for both client education and patient referral because they can enhance the quality of life, longevity, and positive outcomes for various cases across multiple taxa.

Keywords:   Acupuncture; Alternative therapies; Chiropractic; Complementary therapies; Integrative therapies; Nontraditional therapies; Traditional Chinese Veterinary Medicine


From the FULL TEXT Article:

KEY POINTS

  • Nontraditional therapies can be used in conjunction with conventional Western therapies to enhance patient outcome.

  • Nontraditional therapies are often sought out by exotic pet owners; therefore,
    overall understanding is important for general practitioners.

  • Exotic animal species can benefit from the application of nontraditional therapies.

  • Traditional Chinese Veterinary Medicine is tailored to the individual patient
    to optimize health.

  • Chiropractic care can be used as preventative form of treatment and for
    chronic conditions.


INTRODUCTION

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The Provision of Chiropractic, Physiotherapy and Osteopathic Services Within the Australian Private Health-care System

By |April 20, 2018|Chiropractic Care|

The Provision of Chiropractic, Physiotherapy and Osteopathic Services Within the Australian Private Health-care System: A Report of Recent Trends

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SOURCE:   Chiropractic & Manual Therapies 2014 (Jan 15); 22 (1): 3

Roger M Engel, Benjamin T Brown, Michael S Swain, and Reidar P Lystad

Department of Chiropractic,
Macquarie University,
Balaclava Rd, North Ryde 2109,
Australia.


BACKGROUND:   Chiropractors, physiotherapists, and osteopaths receive training in the diagnosis and management of musculoskeletal conditions. As a result there is considerable overlap in the types of conditions that are encountered clinically by these practitioners. In Australia, the majority of benefits paid for these services come from the private sector. The purpose of this article is to quantify and describe the development in service utilization and the cost of benefits paid to users of these healthcare services by private health insurers. An exploration of the factors that may have influenced the observed trends is also presented.

METHODS:   A review of data from the Australian Bureau of Statistics, Australian Health Practitioner Regulation Agency, and the Australian Government Private Health Insurance Administration Council was conducted. An analysis of chiropractic, physiotherapy and osteopathic service utilisation and cost of service utilisation trend was performed along with the level of benefits and services over time.

RESULTS:   In 2012, the number of physiotherapists working in the private sector was 2.9 times larger than that of chiropractic, and 7.8 times that of the osteopathic profession. The total number of services provided by chiropractors, physiotherapists, and osteopaths increased steadily over the past 15 years. For the majority of this period, chiropractors provided more services than the other two professions. The average number of services provided by chiropractors was approximately two and a half times that of physiotherapists and four and a half times that of osteopaths.

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