Talk:Chiropractic: Difference between revisions
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:[Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license. |
:[Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license. |
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:[Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of. |
:[Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of (due to refusing realize that subluxation/somatic lesion had been debunked in the research base and that their guidelines were outdated). |
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:[Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away. |
:[Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away. |
||
:(Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1) |
:(Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1) |
Revision as of 14:35, 18 April 2013
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Treatment, Safety (Proposed revision, March 2013) Part 1 of 2
Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:
- manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
- exercise, rehabilitative programmes and other forms of active care;
- psychosocial aspects of patient management;
- patient education on spinal health, posture, nutrition and other lifestyle modifications;
- emergency treatment and acute pain management procedures as indicated;
- other supportive measures, which may include the use of back supports and orthotics;
- recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.
Manual and manipulative therapy
The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques[1] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[2] Spinal manipulation gained mainstream recognition during the 1980s.[3] Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.[4] It is the most common and primary intervention used in chiropractic care;[5] In North America, chiropractors perform over 90% of all manipulative treatments[6] with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[7] Typically, it is performed on patients who have failed to respond to other forms of treatment.[8]There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.[9] Although serious injuries and fatal consequences can occur and may be under-reported,[10] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.[11]
Definitions
High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation [12] It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.
Categories
Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.[13] Manual and mechanically-assisted articular manipulative procedures can include:
- HVLA manipulation
- HVLA manipulation with recoil
- LVLA manipulation (mobilization)
- Drop tables and terminal point manipulative thrust
- Flexion-distraction and traction-type tables
- Pelvic blocks
- Instrument assisted manipulative devices
Manual non-articular manipulative procedures can include:
- Reflex and muscle relaxation procedures
- Muscle energy techniques
- Myofascial ischemic compression procedures
- Myofascial, and soft tissue manipulative techniques
show full draft
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Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:
Manual and manipulative therapyThe medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques[1] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[2] Spinal manipulation gained mainstream recognition during the 1980s.[14] Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.[4] It is the most common and primary intervention used in chiropractic care;[5] In North America, chiropractors perform over 90% of all manipulative treatments[15] with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[16] Typically, it is performed on patients who have failed to respond to other forms of treatment.[17]There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.[9] Although serious injuries and fatal consequences can occur and may be under-reported,[10] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.[11] DefinitionsHigh-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation [18] It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques. CategoriesManual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.[13] Manual and mechanically-assisted articular manipulative procedures can include:
Manual non-articular manipulative procedures can include:
Neuromusculoskeletal and somatovisceral disordersManual and manipulative therapies is a common intervention used primarily by manual medicine practitioners for the treatment of neuromusculoskeletal disorders. Spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain. However the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial.[19] Research status
SafetyThe safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. [11] Most contraindications apply only to the manipulation of the affected region.[36] Adverse events in spinal manipulation studies appear to be under-reported [68] and appear to be more common following HVLA manipulation than mobilization.[69] Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.[9] These events typically dissipates within 24–48 hours [70] Serious injuries and fatal consequences can occur, and are believed to result from upper cervical rotatory manipulation.[71] but are regarded as rare when spinal manipulation is employed skillfully and appropriately.[36] There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.[72][73][74] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.[75] A 2012 systematic review determined that there is insufficient evidence to support any association between cervical manipulation and stroke.[76] Cost-effectivenessSpinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches.[77] Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.[78] References
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No discussion of new POV fork material added (controversy and criticism)
This made the NPOV issue even worse. What is bizarre it was a bold series of edits without any discussion (as is customary). Hence the bold edit is being reverted and IRWolfie is free to discuss why this material should be added. DVMt (talk) 01:28, 3 April 2013 (UTC)
- Please discuss matters in the talk page before making controversial changes. TippyGoomba (talk) 03:35, 3 April 2013 (UTC)
- What part of BRD don't you understand? IRWolfie made a bold series of edits, with no discussion. Then I reverted it and talked about at the talk page. Then you, reverted me (BRRD). The policy is quite clear on this. DVMt (talk) 03:49, 3 April 2013 (UTC)
- You should check with an admin on that. TippyGoomba (talk) 05:40, 3 April 2013 (UTC)
- I think technically it would only be BRRD if the same editor reverted twice. As to the merge, as discussed above, I am in favour of it - it is needed to prevent a WP:POVFORK. Alexbrn talk|contribs|COI 05:52, 3 April 2013 (UTC)
- You should check with an admin on that. TippyGoomba (talk) 05:40, 3 April 2013 (UTC)
- What part of BRD don't you understand? IRWolfie made a bold series of edits, with no discussion. Then I reverted it and talked about at the talk page. Then you, reverted me (BRRD). The policy is quite clear on this. DVMt (talk) 03:49, 3 April 2013 (UTC)
- I'm a little confused. DVMt said the article I merged from was a POV fork (and I agreed), yet he complains when I merge it back, IRWolfie- (talk) 00:15, 4 April 2013 (UTC)
Multiple edit requests from the same user
Edit request on 8 April 2013
This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request. |
24.15.12.217 (talk) 15:14, 8 April 2013 (UTC)
Cost-effectiveness
Analysis of a clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 found that the clinical and cost utilization of chiropractic services based on 70, 274 member-months over a 7-year period demonstrated ==decreases== of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame [201].
Chiropractic Career
Realistic median annual wage of chiropractors was $67,200 in May 2010 [64]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [65]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.
201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract
202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm
203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/
Edit request on 8 April 2013
This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request. |
Nobias500 (talk) 15:50, 8 April 2013 (UTC)
Cost-effectiveness of Chiropractic Care
Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:
-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs
when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [36].
36. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract
Edit request on 8 April 2013
This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request. |
Nobias500 (talk) 16:01, 8 April 2013 (UTC)
Cost-effectiveness of Chiropractic Care
Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:
-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs
when compared with the use of conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [201].
Chiropractic Career
Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.
201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract
202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm
201. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/
Chiropractic Career
Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.
202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm
203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/ — Preceding unsigned comment added by Nobias500 (talk • contribs) 16:03, 8 April 2013 (UTC)
Response to the above requests
I didn't realize Nobias500 (and their unlogged-in ISP) had requested this addition here. I saw that they had added these two identical sections to Chiropractic education and to Doctor of Chiropractic. I got them to fix the referencing of the "career" section and left it in both articles. I deleted the "cost effectiveness" section as irrelevant for those articles, reduced it to a sentence, and moved it to this article. I make no guarantees about this information, I just moved it as a favor to a newbie. If there are problems with the information or the sourcing, anyone may feel free to remove it. --MelanieN (talk) 04:40, 9 April 2013 (UTC)
Change request-Chiropractic mixer guidelines no longer meet the evidence based standard
Hello all, I'd like to dispute the text that reads, "Although mixers are the majority group" and subsequent parts that imply they use an evidence based standard. I think this was done to give the impression that chiropractors are less unethical than they really are and it is inaccurate. According to an appeal filed by Life University in 2001, straight programs are the majority group.
- The District Court committed a further mistake of law by delving into the chiropractic profession’s philosophical debate about its health care role in an attempt to probe whether CCE harbored an improper motive for not reaffirming LUCC’s accreditation. The District Court refused to apply the Wilfred “great deference” standard based on its finding, which was unsupported by any evidence in the record, that “an aggressive group of leaders of the eight liberal chiropractic schools . . . had undertaken a series of corporate manipulations in order to reduce the representation and dominance of the eight conservative chiropractic schools (of which Life was one) . . . which were calculated to give dominance to the liberal minority group over the conservative majority group; [and] the end result has been the disaccreditation of the largest of all the colleges. . . .” R4-28-3-4. Such an inquiry and the District Court’s unfounded speculation were manifestly improper.16 (see page 43 of attached appeal (CCE vs Life University, US Court of Appeals. 11th cir. NO. 03-11020J. April 23, 2003.)
Granted this is from 2003. Since that time enrollment in straight programs has slowed while mixer ones has increased and one program has closed, the satellite branch of the Cleveland College of Chiropractic, regarded as straight by its president, in Los Angeles. (http://www.chirobase.org/03Edu/schoolphilosophy.html). So although the trend has shifted, straight programs traditionally graduate more graduates. In 2003 Life claimed that 2/3 of all practicing chiropractors were straight, a claim that is supported by the reference that states that a majority of chiropractors, whether they be mixer or straight, support the subluxation complex. If mixers were really evidence based they wouldn't support an outdated subluxation/somatic lesion practice model so the reference shows that assertion to be false.
I am having trouble locating that reference but it doesn't matter because I will show that regardless of orientation, all chiropractic programs, whether they be mixer or straight, are based on a form of subluxation diagnosis.
This brings me to my second request for changes. The article is inconsistent in that it cherry picks references from a few academics and minority practitioners to imply that this false majority of mixers is moving towards evidence based practice:
- “and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[16]”
- "However, most practitioners currently accept the importance of scientific research into chiropractic,[5]and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;[21] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[22]
EB practice isn’t a concensus of what chiropractors say it is, but must have an objective standard based in critical thinking. The mixer EB practice model is to perform a differential diagnosis which is followed by screening the musculoskeletal system for subluxations (pseudoscience). The primary difference between the straight version of this is that straights don’t diagnose diseases so will refer out far fewer patients due to undiagnosed illnesses."
Current thinking of the rest of the manipulative professions (PT, DO) recognizes that subluxations are not real lesions and mandates that manipulation is done solely to assist recovery from legitimate diagnosed conditions. (Peter Huijbregts, PT. Clinical Prediction Rules: Time to Sacrifice the Holy Cow of Specificity? The Journal of Manual & Manipulative Therapy. Vol. 15 No. 1 (2007), 5–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565597/pdf/jmmt0015-0005.pdf)
So while in the past guidelines that recognized subluxation findings may have been justifiable as evidence based practice current analysis shows that the assessments are too flawed to use for diagnosis. Former NACM member and published author Tim Mirtz DC admits this is true and writes of the NACM's supposedly evidence based but now outdated subluxation/somatic lesion based guidelines of their time,
- [Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license.
- [Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of (due to refusing realize that subluxation/somatic lesion had been debunked in the research base and that their guidelines were outdated).
- [Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away.
- (Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1)
To a chiropractor, whether he be mixer or straight, the presence of a malady is not a requirement for treatment because evidence of subluxation by itself is considered a risk factor for future disease. So the only difference it makes is whether a DC bills the insurance carrier (for a diagnosed condition+subluxation) or not (subluxation only). Moreover, as more evidence that all chiropractors support subluxation, no chiropratic college teaches that clinical prediction rules be applied in order to stop treatment of patients who show only false positives from subluxation but are otherwise asymptomatic.
So these sections need to be re-written. As Life affirmed, the majority of practicing chiropractors, whether they be mixer or straight program graduates, treat subluxations (aka somatic lesions) in some form, all evidence based practice guidelines are based on subluxation and are not really evidence based, and historically the idea of eliminating subluxation diagnosis, has been defeated by the majority of the profession and is universally rejected by all organizations and schools. Only a few scattered academics have proposed abandoning subluxation diagnosis but there has been no movement to put this into practice, explaining why the majority support subluxation/somatic lesion diagnosis which is falsely portrayed as legitimate evidence based practice when it really is pseudoscience. Abotnick (talk) 13:04, 18 April 2013 (UTC)
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