Foundation of Care Plans
One of the greatest challenges for the clinical application of Chiropractic care
lies in the justification of care plans for patients, which become moving
targets depending on the intent of the care.
We see a wide range of patient care plans across the spectrum of
chiropractic offices which creates confusion and challenges to the profession.
If the intent of care is to simply reduce pain then the
care plan ends once the pain is reduced. However, if the intent is to stabilize
neurological function, then care ends once that has been demonstrated. The important aspect to either of these
examples lies in the ability to measure the outcome of care intent.
Chiropractic has come under criticism due to a lack of
evidence of many claims being made about how Chiropractic alters a patient’s
health. The profession has relied on
subjective responses to substantiate these claims. While this continues to work
on a practice survival approach, it does nothing to bring credibility to the
profession from a science foundation. Therein lies the great challenge to the
future of the chiropractic profession. Chiropractic continues to have post
graduate programs on practice building based on care plans with questionable
foundations. Most Chiropractic colleges have moved the focus of Chiropractic
care from a neurological foundation to physical medicine. This shift in education has moved
Chiropractic into the realm of physical therapy which brings with it a shift in
the intent of care.
Today we find Chiropractic caught in a state of change
with older well established practices setting care plans based on one approach
and new grads setting completely different plans which leaves both the public
and the profession very confused.
The call for evidence based care started several years
ago and while this sounded like progress for the profession, the challenges
became what was to be considered acceptable evidence. Enter the role of health insurance and
billing. The involvement of insurance coverage for Chiropractic has altered the
intent of care due to the need for medical coding. Medical coding is based on
signs and symptoms, so the standard of care is restricted by the reduction or
elimination of these signs and symptoms. This is the reason the Chiropractic
Colleges have moved the profession toward physical therapy and medical billing
models.
Enter the effect of neuroscience in the last 10 years
into this confusion and we have an opportunity to reverse the restrictions
placed on Chiropractic care. The history
of Chiropractic reveals that the intent of the Adjustment was directly linked
to neurological function, albeit a theory of nerve root pressure at the
intervertebral foramen. The critical
issue is that Chiropractic has a neurological foundation. Different techniques
or methods of adjusting added to the challenges within the profession as many
didn’t involve manual (structural) approaches; yet, the patients demonstrated
reduction in signs and symptoms. In many situations patients reported overall
health issues improving.
The missing link over the last 119 years has been the
ability to prove that Chiropractic adjustments directly alter central nervous
function. Today the evidence is in. Three papers have finally proved the
effectiveness of Chiropractic beyond symptom relief. Today you can set care
plans based on a patient’s neurological needs and measure their changes, which
provides evidence to support the need
for care beyond symptom relief.
Now the question is – how long will it take before the
profession and its educational institutions grasp the critical importance of
the neuro-scientific research information and bring the profession back to its
real potential?
Survival of the vibrancy and health of both the profession and individual practices depends on the adoption of Neurologically Based Chiropractic (NBC).
The practice of today is able to measure and address the neurological condition and needs of the patient
and from this determines appropriate care plans. Even the term “wellness” takes
on a new meaning when we can establish care based on a specific neurological
response long after any sign or symptoms have gone. Welcome to the future of
Chiropractic.
See part III of the Truth of the Matter series by clicking HERE.
1 comment