Chiropractors As
the Spinal Health Care Experts

This section was compiled by Frank M. Painter, D.C.
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Newest Studies

A Proposal to Improve Health-care Value in Spine Care Delivery:
The Primary Spine Practitioner

Spine J. 2017 (Oct); 17 (10): 1570–1574 ~ FULL TEXT

Spine care is an increasingly important aspect of worldwide healthcare delivery. The PSP model has the potential to dramatically improve the currently disorganized and costly process of spine care delivery, address concerns about accelerating growth of spine problems, and more efficiently use existing, highly-trained personnel in a way that indirectly expands the primary care workforce. While the model is no panacea, it holds the potential to address a tremendous need, increase efficiencies, and improve healthcare quality and outcomes of an important and expanding patient population.

Spine Care as a Framework for the Chiropractic Identity
J Chiropractic Humanities 2016 (Dec); 23 (1): 14–21 ~ FULL TEXT

We suggest that the chiropractic profession stop the internal bickering about its identity. It is destructive and demotivating for chiropractors and chiropractic students. We suggest that chiropractors globally accept the identity they already have in the public eye, namely, health care professionals who provide care for people with spine-related disorders. Chiropractors are viewed by the general public as specialists for spine and musculoskeletal care, not generalists or alternative PCPs. When the profession markets itself as having multiple personalities or identities, it confuses people outside of the profession.

Spinal Health: The Backbone of Chiropractic’s Identity
J Chiropractic Humanities 2016 (Dec); 23 (1): 22–28 ~ FULL TEXT

Thanks to forward-thinking educators, researchers, clinicians, and politicians, the chiropractic profession faces unprecedented opportunities. Far from diluting its identity, its involvement in collaborative health care teams is consistently strengthening its identity as valued experts in spine care. Contrary to the proclamations of some, such involvement is not the medicalization of chiropractic, but the coming together of attitudes, beliefs, and science in the best interests of the patients we serve.

Beyond the Spine: A New Clinical Research Priority
J Can Chiropr Assoc. 2015 (Mar); 59 (1): 6–12 ~ FULL TEXT

Over the past two decades, clinical research within the chiropractic profession has focused on the spine and spinal conditions, specifically neck and low back pain. However, there is now a small group of chiropractors with clinical research training that are shifting their focus away from traditional research pursuits towards new and innovative areas. Specifically, these researchers are now delving into areas such as brain injury, work disability prevention, undifferentiated chest pain, hip osteoarthritis, and prevention of pain in children and adolescents to name a few. In this paper, we highlight recent research in these new areas and discuss how clinical research efforts in musculoskeletal areas beyond the spine can benefit patient care and the future of the chiropractic profession.

Primary Spine Care Services: Responding to Runaway
Costs and Disappointing Outcomes in Spine Care

Rhode Island Medical Journal 2014 (Oct 1); 97 (10): 47–49~ FULL TEXT

Efforts are underway to reform our health care system to improve efficiency, outcomes, patient satisfaction and costs. In no field is this more critical than that of spine- related disorders, where escalating costs combined with decreasing clinical benefits for patients has reached a breaking point. Traditionally, practitioners have grouped together based on their specialty (orthopedics, otolaryn- gology, etc.). There has been a recent movement to restructure health care delivery into a patient-centered model that teams professionals based on their ability to serve specific patient needs. This article introduces a new service line - primary spine care services - led by a new type of professional - the primary spine practitioner (PSP). This new practitioner type requires a refined and focused skill set and ideally functions within an integrated spine care pathway. The challenges and opportunities presented by primary spine care services are discussed. This service line has already been implemented in a variety of settings.

Differentiating Intraprofessional Attitudes Toward Paradigms In Health
Care Delivery Among Chiropractic Factions: Results From
a Randomly Sampled Survey

BMC Complementary and Alternative Medicine 2014 (Feb 10); 14: 51 ~ FULL TEXT

The purpose of this investigation was to describe and quantify stratification of orthodox and unorthodox attitudes toward health practice among chiropractors, in order to facilitate an understanding of its internal challenges, inform health policy and extend discourse relevant to the relationship with medicine in this era of interprofessional care. It honors the work of Armor and Klerman [7], placing value on the empirical task of determining numbers associated with intraprofessional factions. The distribution of divergent views in chiropractic with respect to orthodox health perspectives in Canada was evaluated using survey-based methods.

Chiropractors as Primary Spine Care Providers:
Precedents and Essential Measures

J Can Chiropr Assoc. 2013 (Dec); 57 (4): 285–291 ~ FULL TEXT

Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a ‘primary spine care provider’ may be a worthwhile niche position to create for society’s needs.

The Rationale for Primary Spine Care Employing Biopsychosocial,
Stratified and Diagnosis-based Care-pathways at a
Chiropractic College Public Clinic:
A Literature Review

Chiropractic & Manual Therapies 2013 (Jun 9); 21 (1): 19 ~ FULL TEXT

Current management practices for low back pain have led to rising costs without evidence of improvement in the quality of care. Low back pain remains a diagnostic and management challenge for practitioners of many types and is now thought to be a leading global cause of disability. Beyond many published clinical practice guidelines, there are emerging, evidence-based care-pathways including stratification according to the patient's prognosis, classification-based management, diagnosis-based clinical decision guides and biopsychosocial models of care. A proposed solution for successfully addressing low back pain is to train residents at a chiropractic college public clinic to function as primary spine care practitioners, employing evidence-based care-pathways.

Changes In Primary Care Physician's Management of Low Back Pain
in a Model of Interprofessional Collaborative Care:
An Uncontrolled Before-after Study

Chiropractic & Manual Therapies 2013 (Feb 1); 21 (1): 6 ~ FULL TEXT

There were twice as many patients in the pre-study group who were prescribed medication compared to the study group. Almost 33% of patients in the pre-study group were concurrently prescribed a second, and 4% a third medication, compared to 6% of patients in study group who received only a second prescription. Despite the similarity in recorded pain severity, there were about 2.6 times more medications prescribed in the pre-study group compared to those in the study group.

The Establishment of a Primary Spine Care Practitioner
And Its Benefits To Health Care Reform in the United States

Chiropractic & Manual Therapies 2011 (Jul 21); 19 (1): 17 ~ FULL TEXT

It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs). Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

A Hospital-Based Standardized Spine Care Pathway:
Report of a Multidisciplinary, Evidence-Based Process

J Manipulative Physiol Ther 2011 (Feb); 34 (2): 98–106 ~ FULL TEXT

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 findings for 518 consecutive patients were included. One hundred sixteen patients 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.

Are Swiss Chiropractors Different Than Other Chiropractors?
Results of the Job Analysis Survey 2009

J Manipulative Physiol Ther 2010 (Sep); 33 (7): 519–535 ~ FULL TEXT

The response rate was 70%. Similarities between Swiss chiropractors and their international counterparts were found in the most common conditions treated, the common etiologies of these conditions, the most common age groups seen, and the most common treatment methods used. Differences were found in the high proportion of patients referred directly to chiropractors from varying medical specialists in Switzerland, the fact that the most common category of patient to be seen by chiropractors in Switzerland is the acute followed by the subacute patient, the much higher requirement for continuing education hours in Switzerland, and the reduced use of diagnostic imaging compared with practitioners from the United States.

How Can Chiropractic Become a Respected Mainstream Profession?
The Example of Podiatry

Chiropractic & Osteopathy 2008 (Aug 29); 16: 10 ~ FULL TEXT

The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise. Several lessons can be learned from the podiatric medical profession in this effort.

Chiropractic As Spine Care:
A Model For The Profession

Chiropractic & Osteopathy 2005 (Jul 6); 13: 9 ~ FULL TEXT

This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.


Reference Materials

The Prescription Rights and Expanded Practice Debate
A Chiro.Org article collection

Tune into the furor generated by a small group of DCs who seek prescription rights so they can expand their practice.   The first section of this page (Background Materials) is a collection of Point/CounterPoint articles, and the second section (Most Recent Additions) are impassioned articles by some of the Profession's best authors.   Tune in and make your choice... drug free, or expansion into the litiginous unknown.

Clinical Prediction Rules
A Chiro.Org article collection

Following in the tradition of the “Diagnosis and Management” page, this collection of articles reviews the development of prediction rules for who might benefit from chiropractic care.

Pain Management and Chiropractic
A Chiro.Org article collection

Explore this collection of articles that discusses the relationship between tissue injury and various pyschosocial factors that may contribute towards developing chronic pain.

Chronic Neck Pain and Chiropractic
A Chiro.Org article collection

Review this extensive collection of studies detailing how chiropractic and spinal manipulation are effective for the relief of spinal pain.

Neck and Back Pain in Children and Chiropractic
A Chiro.Org article collection

We hope you will enjoy this extensive collection of articles and studies demonstrating the benefits of chiropractic care for spinal pain in children.

Radiculopathy and Chiropractic Page
A Chiro.Org article collection

We hope you will enjoy this extensive collection of articles and studies demonstrating the benefits of chiropractic care for radiculopathy.

Low Back Pain and Chiropractic
A Chiro.Org article collection


Clinical Model for the Diagnosis and Management of
Patients with Spinal Pain Syndromes

A Chiro.Org article collection

Review this fascinating collection of articles detailing how to rule-in/rule-out red and/or yellow flags as you assess and manage patients with spinal pain syndromes.

The Chiropractic Scope of Practice in the United States:
A Cross-sectional Survey

J Manipulative Physiol Ther. 2014 (Jul); 37 (6): 363–376
The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.

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