FIG. 2.

Care pathway for chiropractic management of adult patients with chronic musculoskeletal pain.^14,161Evaluation and re-evaluation components: History; perform focused examination; imaging if warranted (new trauma/symptoms/red flags); patient-reported outcome measures (PROMs) (Table 11); pain frequency and intensity; functional ability; quality of life; psychological factors. ²Attempt treatment withdrawal when patient reaches maximum therapeutic improvement. If improvements deteriorate, ongoing care may be necessary to maintain functional status. Withdrawal can be tapered or abrupt. Either instruct patient to return if symptoms recur; or schedule him/her for re-evaluation at regular intervals. ³To document necessity for ongoing care, record: Response to initial treatment (use valid outcome measures); MTI, Maximum Therapeutic Benefit; residual activity limitation; patient's self-care attempts; have alternative treatments been considered or attempted?