In mid-October, more than 100 faculty members from 29 chiropractic colleges in 11 countries attended the World Federation of Chiropractic (WFC) / Association of Chiropractic Colleges (ACC) Education Conference in Toronto.
Following extensive discussion, international educational leaders agreed that the PARTS model (P = pain/tenderness; A = asymmetry/alignment; R = range-of-motion abnormality; T = tone/texture/temperature of soft tissues; and S = special tests) should be adopted by chiropractic colleges and used in practice. They emphasized that a multidimensional approach to patient assessment is needed because individual patient assessment methods have limited evidence of validity and reliability. The PARTS model is already used in several colleges, and also for reimbursement purposes under the U.S. Federal Medicare program.
"Because of different approaches to practice, patients often don't know what to expect when they consult a chiropractor," commented Dr. Jean Moss, president of the ACC and Canadian Memorial Chiropractic College (CMCC). "This represents a significant problem that has to be addressed by the profession."
"The wide variance in methods of patient examination and diagnosis in chiropractic education and practice is obstructing the advancement of the chiropractic profession," added Dr. Anthony Metcalfe, WFC president.
In the opening session of the conference, noted field practitioners from the United States (Dr. Bill Morgan from the National Naval Medical Center in Bethesda, Md.), Canada (Dr. Robert Haig from Ontario, which has nearly 3,000 chiropractors integrated into its workers' compensation, auto insurance and government health care systems), and Europe (Dr. Philippe Druart, president of the European Chiropractors' Union, who has practiced in Belgium for over 30 years), told educators of the current expectations of patients and payors at a time when chiropractic is becoming more prevalent in mainstream health care.
For the remainder of the conference, attendees reviewed various areas of assessment and diagnosis: history and general physical examination, orthopedic and neurological tests, laboratory tests and imaging, and specific chiropractic assessment of subluxation and joint and soft-tissue dysfunction. The final session produced a number of draft consensus statements that will be finalized and published in the future.
"There were many important points agreed [upon]," according to conference directors Dr. Frank Zolli, dean of the University of Bridgeport College of Chiropractic, and Dr. Barry Lewis, lead clinical tutor at Anglo-European College of Chiropractic and president of the British Chiropractic Association, "including the fact that specific functional assessment of the spine, both of joints and soft tissue, should be at the heart of diagnosis in chiropractic education and practice."
Other points of consensus emerging from the conference included:
- Under the PARTS model, individual chiropractors can use their preferred assessment methods, but these should seek objective and recorded information based on the five headings:
P - pain/tenderness
A - asymmetry/alignment
R - range-of-motion abnormality
T - tone/texture/temperature of soft tissues
S - special tests (e.g. imaging and laboratory tests)
- Given the increased integration of chiropractic services in mainstream health care and the increased importance of interdisciplinary understanding and communications, chiropractic students should be taught and chiropractors should utilize a balanced approach to language. This should include equal respect for and use as appropriate of traditional chiropractic terms such as adjustment and subluxation, common scientific language such as manipulation, mobilization and joint dysfunction.
- Although the methods of describing clinical impression or diagnosis have an inconsistency across chiropractic colleges that could be improved, actual methods of patient examination and assessment taught to students are quite consistent - much more so than had been thought. The problem is inconsistency in practice. Recent graduates from all educational programs often seem to abandon methods taught in college in favor of alternative or more simplistic methods advocated by various technique systems and equipment suppliers. Solving this problem would require a coordinated response from colleges, professional associations and regulatory bodies.
For more information on the WFC/ACC Education Conference, or to obtain copies of the conference proceedings in print or on CD, contact Dr. Eleanor White, manager, professional relations, at 416-484-9978 or
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