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PubMed1997

Early Canadian chiropractic colleges.

Chiropractic education arrived in Canada, principally in Ontario, in 1909 with Robbins Chiropractic Institute, (RIC) in Sault Ste. Marie, Ontario. After the RIC's closure in 1913, the Canadian Chiropractic College (CCC) Hamilton, Ontario, held its first classes in 1914 under Dr. Ernest Du Val, 1911 Palmer School of Chiropractic graduate. It was during this period that the Hodgins Commission on Ontario Medical Education held public sessions with presentations from all health professions including chiropractic. It was the outcome of this Commissions Report that dealt a devastating blow to chiropractic. The CCC, which moved to Toronto in 1919, remained the only chiropractic college in Canada until 1920 with the opening of the Toronto Chiropractic College (TCC). The CCC closed in 1923; and the TCC, in 1926. Although all three colleges taught a "straight" program, the "mixers," largely from American schools, became the dominant political force in the province, particularly on the Board of Regents for the enforcement of the 1925 Drugless Practitioners Act, a mixed Board of chiropractors, osteopaths and drugless therapists.

Canada↗
PubMed1992

The visual range of motion scale: analysis of mandibular gait in a chiropractic setting.

The study of skeletal motion is not new to chiropractic. Many methods have been utilized within the chiropractic profession to study or detect aberrant motion. Notably absent in these chiropractic methodologies is motion analysis of the mandible and its bilateral articulations, the temporomandibular joints. The issue of adapting a uniform method of recording mandibular gait becomes especially significant in light of the fact that increasing numbers of patients with temporomandibular disorders are being treated in a chiropractic setting. Chiropractic has traditionally applied or followed carefully described motion analysis routines when investigating the spine or extremities. The purpose of this article, therefore, is to present a method of analyzing mandibular gait (visual range of motion scale) in a chiropractic setting consistent with what is known of the biomechanics and pathomechanics of the mandible and its articulations. Incorporating the visual range of motion scale into the chiropractic examination brings the evaluation of mandibular gait into line with other accepted chiropractic examination procedures.

Chiropractic↗
PubMed1991

Legitimacy at the expense of narrowing of scope of practice: chiropractic in Canada.

A number of researchers from Australia, Britain, the United States and Canada describe the twentieth century development of chiropractic in terms of increased official and public recognition "in exchange for" a narrowing of scope of practice claims. This process in Canada is briefly described and is illustrated by examining chiropractic's relationships with naturopathy, a broad scope of practice health occupation. It is shown that chiropractic in Canada first used naturopathy to try to expand its own scope of practice, but then quickly rejected any official connections with a broad scope naturopathy in a recent drive to gain state recognition for a chiropractic "purified" of its past all-inclusive claims, a drive which has been at least partially successful. Yet, this narrowing contradicts chiropractic's frequent claims to be a holistic health discipline and presents practical problems for chiropractic. While chiropractic is in the process of gaining official recognition under proposed health disciplines legislation in Ontario, it is faced with dilemmas produced by its contradictory claims to narrowing and to holism. At the same time, chiropractic, along with many other previously subordinate health occupations, seems to be in the process of replacing medical dominance with a broader, but perhaps just as authoritarian, regime of "professional dominance." Will success inevitably bring not only an implicit acknowledgement of the claims of orthodox medicine, but also a separation of chiropractors from patients, those whom chiropractors once made a unique claim to serve?

Canada↗
PubMed1993

Manual force, mechanically assisted articular chiropractic technique using long and/or short level contacts.

OBJECTIVE: To identify what has been theorized and/or written about the manual techniques generically classified as manual force, mechanically assisted articular chiropractic technique that utilize either short-lever contacts or a combination of short- and long-lever contacts. DATA SOURCES: A search of the Medline bibliographic database using MeSH key words (chiropractic/methods; osteopathic manipulation) was performed. The Index to Chiropractic Literature and Chiropractic Research Abstracts Collection (CRAC) were searched for the past 10 yr using the key terms of chiropractic-methods; chiropractic techniques; manipulation, chiropractic, manipulation, osteopathic, manipulation, spinal; and manipulation, joint. A hand search of textbooks was undertaken as well as review of the references included in books, monographs and collected papers. STUDY SELECTION: Studies in English were included, but it must be noted that these include publications that are not peer reviewed or refereed in any way. DATA EXTRACTION: Descriptions that discussed aspects of manipulative procedures with the characteristics were extracted by a single author. DATA SYNTHESIS: Very little was found or accessible with traditional methods of literature retrieval. Descriptions of characteristics for the attributes of techniques which use mechanical assistance to impart a force applied to specific contacts in combination with short and long levers are provided. The technique procedures which fall into this category use the mechanical assistance of specialized table parts, including drop sections and distracting sections, to achieve functional changes in the vertebral three-joint complex. Conjecture and speculation as to the advantages of mechanical assistance are presented. CONCLUSIONS: This type of review is considered the first step in the evaluative process for a chiropractic technique procedure. It demonstrates that very little has been written in an accessible fashion relative to techniques which are classified as manual force, mechanically assisted articular chiropractic techniques that utilize either short-lever contacts or a combination of short- and long-lever contacts. Controlled prospective clinical trials to evaluate efficacy in using these technique procedures are nonexistent. Furthermore, there are no comparison studies to determine whether the techniques which fit into this category are any more effective or efficient in producing a positive clinical outcome than techniques in other categories. The proponents of these technique procedures should be performing the studies and publishing the results that either support or deny the usefulness of these procedures.

Chiropractic↗
PubMed1995

Chiropractic referral: the views of a group of conventional medical practitioners with an interest in unconventional therapies.

OBJECTIVE: To identify, from a list of conditions prepared by leaders in the Australian chiropractic profession, disorders that medical practitioners regard as suitable for referral for chiropractic care. DESIGN: A descriptive study in which eight hundred and twenty (820) medical practitioners with an interest in "unconventional" interventions were invited to respond to a mailed questionnaire. PARTICIPANTS: Medical practitioners with a demonstrable interest in at least one form of nonconventional therapy were surveyed. Seven hundred and ninety-six medical practitioners who subscribe to a professional organization committed to "alternative" nutritional approaches in health care were sent mail. Twenty-four practitioners known to be sympathetic to chiropractic were also included. The response rate was 28%. RESULTS: Medical respondents who refer to chiropractors more frequently consider a larger number of conditions suitable for chiropractic care than those who never refer. Referral of patients with visceral disorders enjoys relatively little support, especially among practitioners who never actually use chiropractic referral as an intervention option. Analysis of perceptions regarding chiropractic referral of patients with headaches suggests that the perceived etiology of the symptom is a consideration in making referral decisions. CONCLUSION: Chiropractic referral for musculoskeletal care enjoys substantial support, whereas referral for chiropractic intervention in visceral conditions continues to be largely opposed by those members of the medical profession participating in this study.

Attitude of Health Personnel↗
PubMed1996

Cleveland chiropractic: the early years, 1917-1933.

Although the Cleveland family is well known in the profession for the two colleges that carry its name, relatively few of the details of the early activities of these chiropractic pioneers are recalled. This paper traces the early lives and careers of Ruth Ashworth and Carl S. Cleveland, Sr. from their education and marriage at the Palmer School in 1917 through their college operations and national professional activities before the start of the National Chiropractic Association's educational reform initiatives in the mid-1930s. The pair was active in Missouri chiropractors' struggles for licensure in the 1920s and fought to prevent the enactment of basic science legislation later on. The Clevelands remained allied to B. J. Palmer and the Chiropractic Health Bureau (today's International Chiropractors' Association) after the introduction of the neurocalometer (NCM) in 1924. However, they followed a less strident and less extreme course within straight chiropractic than did their Davenport mentor. The Cleveland College perpetuated a full-spine approach to chiropractic technique and always included diagnostic instruction. In the late 1920s and early 1930s, Carl Cleveland's more moderate stance found favor within the unification efforts centered in the International Chiropractic Congress, and he served during 1931-1933 as president of the Congress' division of school leaders. The Cleveland Chiropractic College's battle for economic survival during the lean days of the nation's economic depression is a testimony to its founders' vision and commitment to chiropractic education.

Chiropractic↗
PubMed1998

A comparative study of chiropractic and medical education.

BACKGROUND: Chiropractic is the largest of the alternative/complementary health professions in North America. However, little attention has been given in the health sciences literature to the formal curriculum of chiropractic education or to its similarities to and differences from the curriculum of allopathic medical education. This lack of information precludes extensive referrals and interaction between the 2 professions, even when historical and political barriers can be overcome. METHOD: This is a descriptive, comparative study of the curriculum content of North American chiropractic and medical colleges, supplemented by in-depth data obtained through site visits with 6 institutions (3 chiropractic and 3 medical). DISCUSSION: Considerable commonality exists between chiropractic and medical programs. Regarding the basic sciences, these programs are more similar than dissimilar, both in the types of subjects offered and in the time allotted to each subject. The programs also share some common areas in the clinical sciences. Chiropractic and allopathic medicine differ the greatest in clinical practice, which in medical school far exceeds that in chiropractic school. The therapies that chiropractic and medical students learn are distinct from one another, and the settings in which students receive clinical training are different and isolated from one another. With these similarities and differences established, future studies should examine the quality of the 2 educational programs in detail.

Chiropractic↗
PubMed2005

Reflex control of the spine and posture: a review of the literature from a chiropractic perspective.

OBJECTIVE: This review details the anatomy and interactions of the postural and somatosensory reflexes. We attempt to identify the important role the nervous system plays in maintaining reflex control of the spine and posture. We also review, illustrate, and discuss how the human vertebral column develops, functions, and adapts to Earth's gravity in an upright position. We identify functional characteristics of the postural reflexes by reporting previous observations of subjects during periods of microgravity or weightlessness. BACKGROUND: Historically, chiropractic has centered around the concept that the nervous system controls and regulates all other bodily systems; and that disruption to normal nervous system function can contribute to a wide variety of common ailments. Surprisingly, the chiropractic literature has paid relatively little attention to the importance of neurological regulation of static upright human posture. With so much information available on how posture may affect health and function, we felt it important to review the neuroanatomical structures and pathways responsible for maintaining the spine and posture. Maintenance of static upright posture is regulated by the nervous system through the various postural reflexes. Hence, from a chiropractic standpoint, it is clinically beneficial to understand how the individual postural reflexes work, as it may explain some of the clinical presentations seen in chiropractic practice. METHOD: We performed a manual search for available relevant textbooks, and a computer search of the MEDLINE, MANTIS, and Index to Chiropractic Literature databases from 1970 to present, using the following key words and phrases: "posture," "ocular," "vestibular," "cervical facet joint," "afferent," "vestibulocollic," "cervicocollic," "postural reflexes," "spaceflight," "microgravity," "weightlessness," "gravity," "posture," and "postural." Studies were selected if they specifically tested any or all of the postural reflexes either in Earth's gravity or in microgravitational environments. Studies testing the function of each postural component, as well as those discussing postural reflex interactions, were also included in this review. DISCUSSION: It is quite apparent from the indexed literature we searched that posture is largely maintained by reflexive, involuntary control. While reflexive components for postural control are found in skin and joint receptors, somatic graviceptors, and baroreceptors throughout the body, much of the reflexive postural control mechanisms are housed, or occur, within the head and neck region primarily. We suggest that the postural reflexes may function in a hierarchical fashion. This hierarchy may well be based on the gravity-dependent or gravity-independent nature of each postural reflex. Some or all of these postural reflexes may contribute to the development of a postural body scheme, a conceptual internal representation of the external environment under normal gravity. This model may be the framework through which the postural reflexes anticipate and adapt to new gravitational environments. CONCLUSION: Visual and vestibular input, as well as joint and soft tissue mechanoreceptors, are major players in the regulation of static upright posture. Each of these input sources detects and responds to specific types of postural stimulus and perturbations, and each region has specific pathways by which it communicates with other postural reflexes, as well as higher central nervous system structures. This review of the postural reflex structures and mechanisms adds to the growing body of posture rehabilitation literature relating specifically to chiropractic treatment. Chiropractic interest in these reflexes may enhance the ability of chiropractic physicians to treat and correct global spine and posture disorders. With the knowledge and understanding of these postural reflexes, chiropractors can evaluate spinal configurations not only from a segmental perspective, but can also determine how spinal dysfunction may be the ultimate consequence of maintaining an upright posture in the presence of other postural deficits. These perspectives need to be explored in more detail.

Journal Article↗
PubMed2005

A Chiropracticness Test.

BACKGROUND: There is little homogeneity of opinion in the chiropractic profession about its essence and identity. Matters compromising the establishment of a coherent identity include the issue of vertebral subluxation, philosophy, mercantilism, poverty of qualifications in some chiropractic college faculty, and lack of intellectual productivity in some chiropractic college faculty. DISCUSSION: The Chiropractic profession has mislabeled rhetoric, supposition and cant as philosophy, whilst showing sparse evidence for the existence of more than a few chiropractors writing in philosophy as a discipline. There is no evidence for "Chiropractic Philosophy". I propose, however, that a better use of the discipline of philosophy can be of great use to the Chiropractic profession. Various thinkers throughout the ages have written about deduction, induction and falsificationism as methods to discover more reliably the nature of things in the world about us. Each method has strengths and frailties, but some of the latter are insurmountable for our purposes. SUMMARY: Using a contrivance of that method which seems most suited, sui generis, for the purpose, I propose a Chiropracticness Test as a tool to assist the search for essence and identity in Chiropractic.

Journal Article↗
PubMed2004

Cutaneous two-point discrimination thresholds and palpatory sensibility in chiropractic students and field chiropractors.

OBJECTIVE: To investigate differences in cutaneous 2-point discrimination and palpatory sensibility at different stages in a chiropractic training course and in field chiropractic practitioners. METHODS: Static 2-point discrimination and palpation thresholds of the skin in the dominant index finger were measured in 102 subjects taken from the first and final years of a chiropractic degree/masters course and practicing field chiropractors. Two-point discrimination measurements were obtained by applying modified electronic engineering calipers mounted on a lever arm, which allowed the points to be lowered onto the skin at a constant rate and pressure. Palpation measurements were made by locating a nylon monofilament under a variable number of sheets of paper held in a purpose-designed frame. Paper thickness was measured by using electronic engineering calipers. Differences in the 2-point discrimination and palpation threshold measurements recorded between cohorts were analyzed by using 1-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparison tests. RESULTS: A statistically significant reduction was observed in 2-point discrimination thresholds between first-year (control group) and fifth-year chiropractic students (P <.001) but not between the control group and the practicing field chiropractors. A progressive increase was observed in palpatory sensibility, as determined by the thickness of paper through which the nylon monofilament could be felt, from first-year chiropractic students to practicing field chiropractors. A significant difference in palpatory threshold was also found between first year students and chiropractors (P <.05). Although both 2-point discrimination and palpatory discrimination thresholds were different between groups, no statistically significant correlation could be made to link statically recorded 2-point discrimination acuity with palpatory sensibility. CONCLUSION: These investigations support previous research that 2-point discrimination improved through the chiropractic training program at the Anglo-European College of Chiropractic but that this appeared not to be retained into field practice. However, the changes in palpatory ability were maintained and improved on in professional practice, suggesting that 2-point discrimination thresholds do not provide a good measure of palpatory ability.

Adult↗
PubMedDate not supplied

The effect of low force chiropractic adjustments for 4 weeks on body surface electromagnetic field.

OBJECTIVE: To study the effects of 4 weeks of low-force chiropractic adjustments on body surface electromagnetic fields (EMFs). METHOD: Thirty-five chiropractic students randomly assigned into control (17 subjects) and experimental groups (28 subjects). A triaxial fluxgate magnetometer was used for EMF detection. The subjects' body surface EMF was determined in the prone position before and after the chiropractic adjustment. A Toftness low-force chiropractic adjustment was applied to the cervical, thoracic, lumbar, and sacral areas as determined by the practitioner. Heart rate variability analysis was recorded once a week to determine autonomic nervous system activity in both the control and experimental groups. RESULTS: The EMF on the subjects' body surface decreased after chiropractic adjustment at the cervical, thoracic, lumbar, and sacral regions in all 6 visits during the 4-week treatment period. The EMF showed a downtrend over the 4-week period after the low-force adjustment. The same changes were not observed in the control group. The chiropractic adjustment group had a slight decrease in heart rate over the 4-week treatment period, and no significant change was observed in the control group. Heart rate variability analysis did not show consistent changes before and after the low-force adjustments during the treatment period. CONCLUSION: Low-force chiropractic adjustment in the cervical and thoracic areas resulted in a consistent reduction of the body surface EMF after 4 weeks of active treatment. No statistically significant differences were found in the heart rate and heart rate variability in the 4-week study.

Adult↗
PubMed2005

Assessment of knowledge of primary care activities in a sample of medical and chiropractic students.

OBJECTIVE: To examine the influence of chiropractic education on knowledge of primary care tasks. Scores received on a test of knowledge of primary care tasks were compared between 3 samples of chiropractic students and 1 small sample of medical students. DATA SOURCES: The taxonomy of primary care tasks that was previously published provided the basis for test items used in this study. A team of test writers prepared an evaluation instrument that was administered to final-term chiropractic students at 3 colleges and to a small sample of medical students as they were entering their residency programs. RESULTS: The chiropractic students scored below the medical students on the primary care examination in every area except musculoskeletal conditions. Chiropractic students scored higher than medical students on the musculoskeletal portion of the examination. CONCLUSIONS: In this sample, chiropractic students performed almost as well as medical students on a test that was designed to measure knowledge of primary care tasks. If the premise is accepted that medical school is the gold standard of primary care instruction, that chiropractic students fared almost as well as medical students is noteworthy.

Chiropractic↗
PubMed2005

Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.

OBJECTIVES: To identify relative provider costs, clinical outcomes, and patient satisfaction for the treatment of low back pain (LBP). METHODS: This was a practice-based, nonrandomized, comparative study of patients self-referring to 60 doctors of chiropractic and 111 medical doctors in 51 chiropractic and 14 general practice community clinics over a 2-year period. Patients were included if they were at least 18 years old, ambulatory, and had low back pain of mechanical origin (n = 2780). Outcomes were (standardized) office costs, office costs plus referral costs for office-based care and advanced imaging, pain, functional disability, patient satisfaction, physical health, and mental health evaluated at 3 and 12 months after the start of care. Multiple regression analysis was used to correct for baseline differences between provider types. RESULTS: Chiropractic office costs were higher for both acute and chronic patients (P < .01). When referrals were included, there were no significant differences in either group between provider types (P > .20). Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction (P < .01); clinically important differences in pain and disability improvement were found for chronic patients only. CONCLUSIONS: Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain.

Acute Disease↗
PubMed2006

Chiropractic users and nonusers: differences in use, attitudes, and willingness to use nonmedical doctors for primary care.

OBJECTIVE: To determine the differences in attitudes and other determinants of care-seeking behavior between persons who have used chiropractic services and persons who have not. A second objective is to determine the interest in members of these 2 groups in choosing nonmedical doctors for providing routine services. METHODS: In 1998, a nationwide telephone survey of randomly selected households in the United States was done, including 400 adults who have used chiropractic services and 400 adults who have not. Survey participants were asked about their use, knowledge, and attitudes about chiropractic care, attitudes about personal role in health care, current source of obtaining usual and routine care, and willingness to consider use of nonmedical doctors as the usual source of such care. The analysis compares persons who have used with those who have not used chiropractic services by using a chi2 test to determine significance of differences between the responses of the 2 groups. A multivariate analysis is done of willingness to use alternative providers for routine care. RESULTS: Persons who have seen a doctor of chiropractic before have different attitudes and preferences about health and health care than others who have never seen a doctor of chiropractic. Almost all of persons in both groups have medical doctors that they use for routine care, and a sizeable portion of both groups would be willing to consider using a nonmedical doctor for this role. Although willingness to use a chiropractor in this role is much higher among persons who have used a chiropractor before, both groups would prefer physician assistants and nurse practitioners to chiropractors in this role. CONCLUSION: For persons participating in this survey, unwillingness to accept the idea of a chiropractor in a primary care role may be largely due to poor knowledge about chiropractic care.

Adolescent↗
PubMed2007

An examination of musculoskeletal cognitive competency in chiropractic interns.

OBJECTIVE: This study investigates the cognitive competency of final-year chiropractic students in musculoskeletal medicine. METHODS: The face, content, and criterion validity of the Basic Clinical Examination (BCE) for musculoskeletal medicine were tested for use in chiropractic education. After validity testing, the BCE was administered in a cross-sectional design to all fourth year students (154) attending the Canadian Memorial Chiropractic College. RESULTS: Twenty percent (5 questions) of the BCE was deemed not relevant or outside of the scope of practice by criterion experts. One hundred twenty-three (80%) fourth year chiropractic interns participated in the cross-sectional study. Interns achieved a 51.2% passing rate (mean score, 73.2%; 95% confidence interval, 82%-71.8%) for the 25-item BCE, whereas the criterion experts achieved a 100% passing rate. For the modified 20-item BCE, the interns' mean score was 80.8%, whereas the criterion experts' mean score rose to 92.8%. CONCLUSIONS: Most final-year chiropractic interns at this college were [corrected] found to be competent in musculoskeletal medicine as assessed by the Basic Competency Examination. This is in contradiction to previous work with medical students, recent medical graduates, nonorthopedic staff physicians, osteopathic students, and physical therapy students. Chiropractic clinicians with postgraduate training showed considerably better results than chiropractic interns. Problems pertaining to the content validity (relevance and scope of practice for chiropractors) of the BCE need to be addressed.

Chiropractic↗
PubMed2007

Patient perceptions of chiropractic treatment for primary care disorders.

OBJECTIVE: Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat. METHODS: A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information, (2) whether their chiropractor was their primary care physician, and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients. RESULTS: There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each 'primary care condition' listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly with many conditions showing an affirmative response of higher than 50% especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions. CONCLUSIONS: Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions.

Adult↗
PubMed1999

Comparison of work and time estimates by chiropractic physicians with those of medical and osteopathic providers.

BACKGROUND: Resource-based relative value scales (RBRVS) have become a standard method for identifying costs and determining reimbursement for physician services. Development of RBRVS systems and methods are reviewed, and the RBRVS concept of physician "work" is defined. OBJECTIVE: Results of work and time inputs from chiropractic physicians are compared with those reported by osteopathic and medical specialties. Last, implications for reimbursement of chiropractic fee services are discussed. METHODS: Total work, intraservice work, and time inputs for clinical vignettes reported by chiropractic, osteopathic, and medical physicians are compared. Data for chiropractic work and time reports were drawn from a national random sample of chiropractors conducted as part of a 1997 workers' compensation chiropractic fee schedule development project. Medical and osteopathic inputs were drawn from RBRVS research conducted at Harvard University under a federal contract reported in 1990. Both data sets used the same or similar clinical vignettes and similar methods. Comparisons of work and time inputs are made for clinical vignettes to assess whether work reported by chiropractors is of similar magnitude and variability as work reported by other specialties. RESULTS: Chiropractic inputs for vignettes related to evaluation and management services are similar to those reported by medical specialists and osteopathic physicians. The range of variation between chiropractic work input and other specialties is of similar magnitude to that within other specialties. Chiropractors report greater work input for radiologic interpretation and lower work input for manipulation services. CONCLUSIONS: Chiropractors seem to perform similar total "work" for evaluation and management services as other specialties. No basis exists for excluding chiropractors from using evaluation and management codes for reimbursement purposes on grounds of dissimilar physician time or work estimates. Greater work input by chiropractors in radiology interpretation may be related to a greater importance placed on findings in care planning. Consistently higher reports for osteopathic work input on manipulation are likely attributable to differences in reference vignettes used in the respective populations. Research with a common reference vignette used for manipulation providers is recommended, as is development of a single generic approach to coding for manipulation services.

Chiropractic↗
PubMed2004

Chiropractic care in asthma and allergy.

OBJECTIVE: To provide a brief overview of the current state of evidence for chiropractic care, specifically in the management of asthma and to a lesser extent allergy. DATA SOURCES: A search of MEDLINE for English-language articles published between January 1966 and July 2002 was conducted using the keywords asthma, allergy, manual therapy, physical therapy techniques, chiropractic, physical therapy (specialty), physiotherapy, massage, and massage therapy. A hand search of the primary chiropractic and osteopathic literature on the treatment of asthma was performed, and proceedings from a recent research symposium on spinal manipulation were included. STUDY SELECTION: Clinical controlled studies and systematic reviews on spinal manipulative therapy (SMT) and asthma were selected. There were no primary clinical trials on SMT and allergy found. RESULTS: Many of the claims of chiropractic success in asthma have been primarily based on anecdotal evidence or uncontrolled case studies. Three recently reported randomized controlled studies showed benefit in subjective measures, such as quality of life, symptoms, and bronchodilator use; however, the differences were not statistically significant between controls and treated groups. There were no significant changes in any objective lung function measures. The clinical issues emanating from these trials are discussed. CONCLUSIONS: There is currently no evidence to support the use of chiropractic SMT as a primary treatment for asthma or allergy. Based on reported subjective improvement in patients receiving chiropractic care, certain clinical circumstances may warrant a therapeutic trial in patients with asthma. Further properly designed, collaborative research is needed to determine if there is a role for chiropractic SMT in the care of asthma or allergy.

Asthma↗