Manipulation
- Consider manipulative treatment within the first six weeks for patients who need additional help with pain relief or who are failing to return to normal activities.
Back Exercises
- Patients who have not returned to ordinary activities and work after six weeks should be referred for reactivation/rehabilitation.
While the support for "manipulation" is not as strong as the chiropractic profession would like to see, the British guidelines do establish the efficacy of chiropractic manipulation for acute low back pain, particularly to a much less doubtful medical profession.
February 1997: ACC Position Papers Born of Consensus
The Association of Chiropractic Colleges (ACC) has taken a second step toward meaningful chiropractic consensus. The first stride was made when the chiropractic college presidents put their signatures to their first position paper, "The ACC Chiropractic Paradigm," published in July 1996.
The association has now released a second position paper, "ACC Chiropractic Scope and Practice." In reading the two position papers, keep in mind they are the result of an intense consensus effort of the ACC. As the cover letter suggests, they are an effort to "clarify our professional common ground and define chiropractic's role within the health care delivery system." Each of the college presidents contributed to these position points, which cover chiropractic practice, scope, paradigm and the subluxation.
Note: Both ACC position papers were inserted in Dynamic Chiropractic for handy reference by readers. If you happen to keep print copies of DC on hand, you can find the first ACC position paper in the Sept. 12, 1996 issue and the second position paper in the Feb. 14, 1997 issue.
April 1997: South Korean University to Begin Chiropractic Course
The path is now clear for formal chiropractic education to be introduced into the university system of South Korea. Under the terms of an agreement between Hanseo University of Korea and RMIT University in Melbourne, Australia, both universities will work with the Korean chiropractic and health care communities to begin teaching a formal, university-level chiropractic-degree course.
Professor David Beanland, vice chancellor of RMIT University, said RMIT was already a highly successful international university, being one of the top destinations in the world for international students. He said the agreement with Hanseo University was a step forward in the development of RMIT as a global university.
The co-founder of Hanseo University, Professor Kee-sun Ham, said the agreement with RMIT University held tremendous promise for the youth of Korea. Professor Ham said the Korean community could only benefit from students having the choice to study chiropractic. He also commented that Hanseo University had worked closely with the Korea International Chiropractic Institute to examine chiropractic programs around the world for their suitability for introduction into Korea. They found the only program that met their expectations and standards was the one at RMIT.
Professor Andy Kleynhans, who heads up RMIT's department of chiropractic, osteopathy and complementary medicine, reported negotiations had been underway for some years. An extremely rigid set of criteria had to be met before RMIT would consider entering into partnership with a Korean university. Professor Kleynhans said they were especially delighted to be working with Hanseo University, given both the high level of commitment and dedication of the Hanseo University management team, and their success in establishing a high quality university in the precinct identified by the Korean government for technology, education and information services.
Professor Kleynhans said RMIT was consulting with the Korean Embassy in Canberra and the Australian Embassy in Korea to ensure introduction of the program complied with both the Australian and Korean government requirements. Professor Kleynhans noted that the president of the World Federation of Chiropractic, Dr. John Sweaney, recently had visited South Korea and had met with representatives of the Korean Chiropractic Association, Hanseo University and the Korea International Chiropractic Institute. Professor Kleynhans said the introduction of chiropractic education into Korea would be in full accord with the WFC's charter for the introduction of chiropractic education into other countries.
Day-to-day management of the program is the responsibility of Dr. Phillip Ebrall, RMIT director of international chiropractic programs. According to Dr. Ebrall, RMIT is now in the unique position of having three delivery sites for its undergraduate program. Dr. Ebrall said the outstanding success of the chiropractic program at RMIT Japan, with its efficient delivery of a quality university degree in Japanese, clearly demonstrates the appropriateness of socializing chiropractic education to suit the community in which it is delivered.
April 1997: Denmark University Establishes Five-Year Chiropractic Program
Until 1994, Scandinavian students seeking a chiropractic education began with one year of basic science studies at Odense University. To pursue their chiropractic education, they had to bear the financial hardship of study abroad at a CCE-accredited chiropractic college.
Since 1994, Odense University has offered its chiropractic students a three-year bachelor's degree. Last September, on the university's 30th anniversary, the Danish minister of education announced the establishment of a state-funded five-year chiropractic program leading to a master's degree in clinical biomechanics. The new Danish chiropractic program will accept 50 students a year.
After completion of the course, which includes a five-month internship at a new, specialized hospital for back pain patients and completion of a one-year postgraduate course, the graduating DCs will be fully authorized to practice by the Danish health authorities.
"The new research-based chiropractic education at Odense University will strengthen the important cooperation between medical doctors, physiotherapists, and chiropractors, benefiting back pain sufferers," said Troels Gaard, DC, president of the Danish Chiropractors' Association.
Dr. Gaarde noted that Odense will play a prominent role in future spinal research and education because of the link between Odense University Hospital and the new back pain center, where MDs, DCs and PTs will work together. The Nordic Institute for Chiropractic and Clinical Biomechanics, where spinal research is ongoing, is located in Odense, which will further enhance the research environment.
As of 1997, nearly 300 chiropractors practice in Denmark, treating 250,000 patients a year. (Denmark's population is approximately 5 million.) The chiropractic profession is legislated by the Danish government, which reimburses DCs about 20 percent on chiropractic treatment.
August 1997: CBO Estimates $2 Billion Chiropractic Medicare Increase in Next 10 Years?
On Aug. 5, President Clinton signed into law the Balanced Budget Act of 1997, six days after it was passed by the U.S. Congress. This historic piece of legislation is expected to save the federal treasury an estimated $115 billion over the next five years. Among other things, the new law is intended to reduce the federal budget, provide tax relief for millions of Americans and preserve the solvency of the Medicare program into the next century. Included in the legislation are a number of provisions and proposals that will benefit the chiropractic profession in the coming years.
X-Ray Barrier Eliminated
One reform incorporated in the final bill is a provision of President Clinton's original budget proposal that eliminates the mandatory X-ray requirement for access to chiropractic services under Medicare. The provision is similar to stand-alone legislation introduced earlier in the year, at the request of the American Chiropractic Association, by Rep. Phil Crane (R-Ill.) and Senate Minority Leader Tom Daschle (D-S.D.).
The new provision removes an intentional barrier to chiropractic care that was placed in Medicare law more than 20 years ago by the medical lobby during the height of the AMA-led boycott of the chiropractic profession. Under the terms of the Balanced Budget Act, the new provision abolishing the mandatory X-ray becomes effective Jan. 1, 2000.
According to statements by senior Health Care Financing Administration (HCFA) official Barbara Wynn, the agency is expected to continue reimbursement for X-rays taken on the referral of a chiropractor when considered medically necessary. HCFA is expected to work closely with the ACA to determine appropriate criteria for the identification of subluxations in those cases in which X-rays are not taken.
Medicare-Managed Plans Can No Longer Discriminate
In a setback to the managed-care industry, House and Senate conferees accepted a provision that prohibits provider discrimination based solely on the license of the individual provider. This provision, supported by an ACA-led coalition of non-MD provider groups, is similar to a provision contained in the Patient Access to Responsible Care Act (PARCA).
ERISA Expansion Denied
The final version of the bill eliminated a House provision that would have allowed small businesses and individuals to obtain health insurance through a mechanism circumventing state regulatory authority and expanding the Employee Retirement Income Security Act (ERISA) preemption. Known as Multiple Employer Welfare Arrangements (MEWAs), these provisions would have further eroded the effectiveness of state any-willing-provider, insurance-equality and similar anti-managed-care laws. The MEWA provisions were vigorously opposed by the ACA and other groups.
Managed Care "Gag Clauses" Made Illegal
The final legislation also contains a provision that prohibits any interference with open communication between doctor and patient in a managed-care environment. This provision eliminates one of the major abuses common in managed care. Now, patients have access to easily understandable information about the plan's health care policies, particularly coverage details and the plan's history of patient satisfaction.
Medical Lobby Fails to Kill Medicare Practice Expense Overhaul
Efforts to kill a planned overhaul of the practice-expense component of the Medicare fee schedule were defeated. After prolonged negotiation, Congress agreed to a one-year delay and a three-year phase-in of the new practice-expense reimbursement rates. Full implementation of the new fee schedule component is estimated to ultimately add as much as 14 percent to overall chiropractic reimbursement in the Medicare program.
October 1997: Chiropractic Effective for Cervicogenic Headache
A study published recently in the Journal of Manipulative and Physiological Therapeutics (JMPT) suggests "spinal manipulation has a significant positive effect in cases of cervicogenic headache." The study compared 53 subjects who had cervicogenic headaches in accordance with the standards of the International Headache Society. Approximately half of the group received chiropractic manipulation. The other group (soft-tissue) received low-level laser and deep-friction massage. Care was administered in six sessions over three weeks. Each subject was examined prior to treatment and at the five-week mark. Data analysis was completed by a blinded observer.
While both groups improved with care, improvement of the soft-tissue group was only statistically significant for the number of headache hours per day. The manipulation group's improvements were statistically significant for all three measurement criteria. Specifically, subjects receiving manipulation for their cervicogenic headache:
- decreased their analgesic use by 36 percent;
- decreased their headache hours by 69 percent; and
- decreased their headache intensity by 36 percent.
While the results of this study may not be good news to the makers of over-the-counter pain medication, it should be encouraging that chiropractors now have a randomized, blinded study to confirm a significant part of their clinical experience.
Source: Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manip Physiol Ther, 1997;20:326-30.
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