Duration of Care 7. Duration of Care for Correction of Vertebral SubluxationRECOMMENDATION
Since the duration of care for correction of vertebral subluxation is patient specific, frequency of visits should be based upon the reduction and eventual resolution of indicators of vertebral subluxation. Since neither the scientific nor clinical literature provides any compelling evidence that substantiates or correlates any specific time period for the correction of vertebral subluxation, this recommendation has several components which are expressed as follows:
a) Based on the variety of assessments utilized in the chiropractic profession, the quantity of indicators may vary, thus affecting the periodicity of their appearance and disappearance, which is tantamount to correction of vertebral subluxation.
b) Vertebral subluxation, not being a singular episodic event such as a strain or sprain, may be corrected but reappear, which necessitates careful monitoring and results in a wide variation in the number of adjustments required to affect a longer-term correction.
c) Based on the integrity of the spine in terms of degree and extent of degeneration, the frequency of assessments, and the necessity for corrective adjustments, may vary considerably.
d) Because the duration of care is being considered relative to the correction of vertebral subluxation, it is independent of clinical manifestations of specific dysfunctions, diseases, or syndromes. Treatment protocols and duration of care for these conditions are addressed in other guidelines, which may be appropriate for any practitioner whose clinical interests include alleviation of such conditions.
Rating: Established
Evidence: E, L
Commentary
Attempts have been made to identify an appropriate number and frequency of chiropractic visits based on type of condition and degree of severity.(1-24) Unfortunately, these recommendations are based merely on consensus, and research to support these recommendations is lacking. Moreover, little to no delineation has been made in the duration of care literature base between care for specific symptomatic profiles such as low-back pain, and long-term subluxation-specific care.
Two studies were found which addressed quality of life issues in patients under chiropractic care. One large, well-designed retrospective study assessing patient reported quality of life found no clinical end point where improvement reached a plateau.(25) A second study involved a detailed examination of a database collected during a randomized clinical trial testing the effectiveness of a comprehensive geriatric assessment program. It was reported that compared to non-chiropractic patients, chiropractic patients in this population were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. Furthermore, they were less likely to use prescription drugs.(26)
It is the position of the Guideline Panel that individual differences in each patient and the unique circumstances of each clinical encounter preclude the formulation of "cookbook" recommendations for frequency and duration of care.
The appropriateness of chiropractic care should be determined by objective indicators of vertebral subluxation.
References
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22. Jarvis KB, Phillips RB, Morris EK. Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. J Occup Med 1991; 33:847-52.
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25. Blanks RH, Schuster TL, Dobson M. A retrospective assessment of network care using a survey of self-rated health, wellness, and quality of life. Journal of Vertebral Subluxation Research 1997; 1(4):15-31.
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