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Chiropractic, One Big Unhappy Family:
Better Together or Apart?

By |September 10, 2019|Evidence-based Practice|

Chiropractic, One Big Unhappy Family:
Better Together or Apart?

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2019 (Feb 21); 27: 4

Charlotte Leboeuf-Yde, Stanley I. Innes, Kenneth J. Young, Gregory Neil Kawchuk and Jan Hartvigsen

Institute for Regional Health Research,
University of Southern Denmark, DK-5000
Odense C, Denmark.


Editorial Comment:

It’s with heavy heart that I realize that it’s all come down to this: chiropractic depicted as a bad soap-opera marriage.

What is more upsetting is that this article is penned by some of the best, brightest and most-published of our chiropractic researchers. I love these folks!

That said, I’d like to challenge some of their assumptions. Chiropractic is not a marriage between chiropractors. At best, it’s a Family.

And families interact. I just might marry your sister, for example.

Now you may not like me, or you may not like our marriage. But that’s a personal problem.

The word Evidence has taken on a sacred-cow glow lately, and is only eclipsed by the adoption of the word skeptic by every Tom, Dick and Harry blog-opinionist/critic on the planet. So, let’s set the stage for the conversation.

This article dishes up several reasons why (as they call themselves) the ‘evidence-friendly’ faction are opposed to the ‘traditional’ group.

Here’s a short list of the infractions that are practiced by the ‘traditionalists’

  1. They ‘believe’ in “subluxations”

  2. Some of them ‘believe’ that you can find “subluxations” on x-rays

  3. Some of them ‘believe’ that correcting “subluxations” leads to improved health

So let’s address these concerns, one at a time.

  1. The Medicare and Medicaid definition of “subluxations” is:

“Subluxation is defined as a motion segment, in which alignment, movement integrity, and/or physiological function of the spine, are altered, although contact between joint surfaces remains intact.” [1] (page 3)

Naturally, we can argue all we want about the accuracy of this term, until we turn blue in the face… BUT this is the definition adopted by the Government of the United States of America.

Then, to bill Medicare for that spinal manipulation, I must use one of the 3 CPT codes that describe
Chiropractic Manipulative Therapy
(CPT codes 98940–98942)

AND

I must use an ICD-10 code to describe
WHAT I adjusted:

M99.01   Segmental and somatic dysfunction of cervical region

Medicare enjoys being exclusive, and has always been the allopathic boy’s club, so they don’t permit us to use the mildly more accurate ICD-10 codes:

M99.11     Subluxation complex (vertebral) of cervical region

M99.12   Subluxation complex (vertebral) of thoracic region

M99.13   Subluxation complex (vertebral) of lumbar region

M99.14   Subluxation complex (vertebral) of sacral region

M99.15   Subluxation complex (vertebral) of pelvic region

As an aside, the AAPC states that

“The International Classification of Diseases (ICD-10) is the standard international diagnostic classification system for documenting all general epidemiological conditions.” [2]

Houston, we have a problem. (LOL)

Our ‘evidence-friendly’ pals have a real problem on their hands. It’s not just the U.S. they have to contend with, it’s the whole international community, which has adopted the ICD-10 mechanism to describe the subluxation.  My recommendation:   Pack a lunch.


Who gets to decide that we need a NEW word to describe WATER?

Hell, with all the pollutants in our water supply, what if we simply RENAME water? That will solve the dilemma, right? Really? Oh yeah, the skeptics will finally embrace us if we just call it something else. LOL

Subluxation (as a term) is the word that was adopted way-back-when to describe “that-thing-we-adjust”.

I have yet to hear another term that was more pleasing to the ear, and didn’t smell like an over-anxious submission to organized medicine.

While we’re on the subject, some folks prefer to use the term “manipulate” rather than “adjust”.

I had the pleasure of listening to Virgil Strang, DC’s opinion on that topic. Back in the day, before television became digital, when we changed the channel, we often had to adjust the antenna or the tuner, to get the bext picture. So the term adjust became associated with the concept of fine-tuning.

Now answer me this:   If your woman looks you in the eye, and says: “Don’t manipulate me”, you KNOW you are NOT going to have a nice day. That term carries some unpleasant baggage.

I guess my point is that some terms (manipulate, subluxation etc.) may have developed a bad connotation, particularly after spending enough time reading skeptic blogs. The words themselves are not to blame. Accept it, we’ve been conditioned by the culture and the language in which we are submerged. But, I digress.

  1. Finding “subluxations” on x-rays

I guess that partly depends on what you describe as a subluxation (or that-thing-we-adjust, if you prefer). If it is loss of normal end-feel, or limitations in normal range of motion, or things like that, then yes, the normal AP and lateral film can’t portray that loss of function.

However, a careful videofloroscopic study of the cervical spine reveals a lot of what we feel with palpation.

It’s easy to see facets that fail to slide up or downhill during flexion and extension.

It’s easy to see IVFs failing to open, or to close down during flexion and extension. That should also be correlated with whether the spinous processes fans out, or move closer together, during flexion and extension.

When I say *easy* I mean that when you look at enough of these studies, those things jump out at you.

I had the good fortune to watch Dr. Verne Pierce do VFs on 100+ patients each semester for 7 semesters in a row, and we had access to those studies in our research department at Palmer (Davenport). I started a VF Analysis Club in my 5th tri, and 20-30 interested students popped in each week to view the studies and to talk about what we saw.

  1. Does anyone ‘believe’ that correcting “subluxations” leads to improved health?

LOL! What does belief have to do with it?

Like any other applied scientist, we observe what changes when we adjust a patient. That’s Care 101. You don’t need to believe anything. Just ask your patient IF they feel better, AND does that improvement sustain for longer and longer periods of time?

I like using the RAND SF-36, because it documents 8 different ways that being subluxated impacts their work day, their joy and sense of well-being.

That is the definition of rational care.

All those other distinctions are political, an unpleasant “I’m-cooler-than-you” rap, and it is simply unprofessional. (Well, I do believe you folks ARE cool… just not cooler than me.)

We have national standards, we have State Professional Associations, so if you think someone is doing something unprofessional, then file a complaint, and let them do their job.

All this jabbering in Chiropractic & Manual Therapies, which is famous for it’s “we’re-more-evidence-based-than-you-are” rants, demeans our profession, and slows our progress.


References:

  1. Department of Health and Human Services
    Centers for Medicare & Medicaid Services
    Overview of Medicare Policy Regarding Chiropractic Services

  1. What is ICD-10?


BACKGROUND:   The chiropractic profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care.Because this is an issue with many factors to consider, we decided to illustrate it with an analogy. We aimed to examine the chiropractic profession from the perspective of an unhappy marriage by defining key elements in happy and unhappy marriages and by identifying factors that may determine why couples stay together or spilt up.

MAIN BODY:   We argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. This middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts.

There are more articles like this @ our:

What is the Chiropractic Subluxation? Page

(more…)

Evidence-informed Management of Chronic Low Back Pain with Spinal Manipulation and Mobilization

By |June 11, 2018|Evidence-based Practice|

Evidence-informed Management of Chronic Low Back Pain with Spinal Manipulation and Mobilization

The Chiro.Org Blog


SOURCE:   Spine J. 2008 (Jan); 8 (1): 213–225

Gert Bronfort, DC, PhDa, Mitch Haas, DC, MA, Roni Evans, DC, MS, Greg Kawchuk, DC, PhD, Simon Dagenais, DC, PhD

Northwestern Health Sciences University,
2501 W 84th St,
Bloomington, MN 55431, USA.


The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence Informed Management of Chronic Low Back Pain Without Surgery.

Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

International Web Survey of Chiropractic Students About Evidence-based Practice

By |August 6, 2017|Evidence-based Practice|

International Web Survey of Chiropractic Students About Evidence-based Practice: A Pilot Study

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2011 (Mar 3); 19 (1): 6

Ryunosuke Banzai, Dustin C Derby, Cynthia R Long
and Maria A Hondras

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street, Davenport, IA 52803-5209, USA.


BACKGROUND:   Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles.

METHODS:   We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis.

RESULTS:   Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9).

There are more articles like this @ our:

Evidence-based Practice Page

(more…)

Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

By |April 10, 2017|Chiropractic Care, Evidence-based Practice, Guidelines|

Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2014 (Sep); 58 (3): 206–214

Greg Kawchuk, DC, MSc, PhD, Genevieve Newton, DC, PhD,
John Srbely, DC, PhD, Steven Passmore, Hons BKin, DC, PhD,
André Bussières, DC, FCCS (C), Jason W. Busse, DC, PhD,
and Paul Bruno, BHK, DC, PhD

Associate Professor and Canada Research Chair
in Spinal Function,
Faculty of Rehabilitation Medicine,
University of Alberta


Introduction

This two-part commentary aims to provide clinicians with a basic understanding of knowledge translation (KT), a term that is often used interchangeably with phrases such as knowledge transfer, translational research, knowledge mobilization, and knowledge exchange. [1] Knowledge translation, also known as the science of implementation, is increasingly recognized as a critical element in improving healthcare delivery and aligning the use of research knowledge with clinical practice. [2] The focus of our commentary relates to how these KT processes link with evidence-based chiropractic care.

There are more articles like this @ our:

The Guidelines Section and the:

The Evidence-based Practice Page

(more…)

Self-reported Attitudes, Skills and Use of Evidence-based Practice Among Canadian Doctors of Chiropractic

By |March 25, 2017|Evidence-based Practice|

Self-reported Attitudes, Skills and Use of Evidence-based Practice Among Canadian Doctors of Chiropractic: A National Survey

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2015 (Dec); 59 (4): 332–348

André E. Bussières, DC, PhD, Lauren Terhorst, PhD,
Matthew Leach, RN, BN (Hons), ND, PhD,
Kent Stuber, DC, MSc, Roni Evans, DC, PhD, and
Michael J. Schneider, DC, PhD

Assistant Professor,
School of Physical and Occupational Therapy,
McGill University
Département Chiropratique,
Université du Québec à Trois-Rivières.


OBJECTIVES:   To identify Canadian chiropractors’ attitudes, skills and use of evidence based practice (EBP), as well as their level of awareness of previously published chiropractic clinical practice guidelines (CPGs).

OBJECTIVES:   7,200 members of the Canadian Chiropractic Association were invited by e-mail to complete an online version of the Evidence Based practice Attitude & utilisation SurvEy (EBASE); a valid and reliable measure of participant attitudes, skills and use of EBP.

RESULTS:   Questionnaires were completed by 554 respondents. (7.7% of those invited) Most respondents (>75%) held positive attitudes toward EBP. Over half indicated a high level of self-reported skills in EBP, and over 90% expressed an interest in improving these skills. A majority of respondents (65%) reported over half of their practice was based on evidence from clinical research, and only half (52%) agreed that chiropractic CPGs significantly impacted on their practice.

There are more articles like this @ our:

The Evidence-based Practice Page

(more…)

Discussion Paper: Evidence-Based Practice and Chiropractic

By |January 7, 2017|Evidence-based Practice|

Discussion Paper: Evidence-Based Practice and Chiropractic

The Chiro.Org Blog


Chiropractic Journal of Australia 2016; 44: 308–319 ~ FULL TEXT

Phillip Ebrall

Southern Cross University, Australia;
International Medical University, Malaysia;
Tokyo College of Chiropractic, Japan.


Objective:   To present an objective interpretation of the literature reporting evidence based medicine or practice and to raise discussion points based on those findings which, if explored, may advance the chiropractic profession in both its academic and clinical activities.

Data Sources and Synthesis:   The indexed literature and URLs identified by on-line searching. A contextual narrative identifies specific points that may be worthy of formal discussion, either by individual authors preparing papers for publication, or by symposia.

Conclusion:   Evidence based medicine is thought by some to have had its day. The concept of best practice seems embedded within chiropractic education. Whether they appreciate it or not, most chiropractors practice a rich form of evidence based practice into which they inject their experience as a chiropractor and the characteristics including preferences of the patient.

There are more articles like this @ our:

Evidence-based Practice Page

(more…)