Clinical Assessment 4 Clinical Impression and AssessmentRECOMMENDATIONPractitioners should develop a method of patient assessment which includes a sufficient diversity of findings to support the clinical impression as related to vertebral subluxation.(1-24) In this regard, it is considered inappropriate to render an opinion regarding the appropriateness of chiropractic care without a chiropractic assessment, including a physical examination of the patient by a licensed chiropractor. When management of patient care is carried out in the collaborative setting, the chiropractor, as a primary contact health care provider, is the only professional qualified to determine the appropriateness of chiropractic care. The unique role of the chiropractor is separate from other health disciplines,(25-35) and should be clarified for both the patient and other practitioners. The patient assessment, specific to the technique practiced by the chiropractor, should minimally include a biomechanical and neurophysiological component. It is inappropriate to make a retrospective determination of the clinical need for care rendered prior to the assessment.
Rating: Established
Evidence: E, L
Commentary
The procedures employed in the chiropractic assessment may include some or all of, but are not limited to the following:
Physical examination:Palpation (static osseous, static muscle, motion).
Range of motion.
Postural examination
Comparative leg length (static, flexed, cervical syndrome).
Manual muscle tests.
Nerve function tests.
Mental status examination and psychosocial assessment.
Instrumentation examination:Range of motion.
Thermography.
Temperature reading instruments.
Muscle testing.
Electromyography.
Pressure algometry.
Nerve-function tests.
Electroencephalography and brain mapping.
Bilateral and four quadrant weight scales.
Imaging examination:Spinography.
Videofluoroscopy.
Computerized tomography.
Magnetic resonance imaging.
Following the determination of a clinical impression, the patient should be made aware of the findings and consent to the proposed plan of care.
Literature support for the use of these technologies may be found in the chapters on chiropractic examination, instrumentation and diagnostic imaging (Chapters 1, 2, 3).
References
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