5 Chiropractic Services to Question

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In 2012, the Institute of Medicine released a shocking finding: up to 30% of health care spending in the United States is wasted. To combat the trend of unnecessary care, the Choosing Wisely campaign was established to encourage patients, providers, and healthcare organizations to focus on patient-centered, research-driven medicine. The American Chiropractic Association (ACA) joined the cause, releasing a list of 5 spine care procedures and tests to question.
model of a skeleton holding an x-ray up to a window for lightThe ACA's list was put together as an opportunity to have an open dialogue with patients about what treatment and/or evaluation procedures may be in their best interests.The Choosing Wisely campaign is led by the ABIM Foundation (created by the American Board of Internal Medicine) and Consumer Reports. The ACA is among nearly 100 health care organizations to join the Choosing Wisely campaign.

“Joining the Choosing Wisely campaign encourages a patient-centered, evidence-based approach to treatment and shared decision-making between doctors and patients,” says Christine Goertz, DC, PhD, Chairperson for the ACA Committee on Quality Assurance and Accountability, and ACA Senior Scientific Advisor.

“When health care resources are wasted, it threatens our nation’s ability to deliver the highest quality of care possible to all patients,” Goertz continues.

But, First: Not a “Never” List

While the ACA’s list is designed to help patients and providers have more productive conversations about the appropriate direction of care, it should not be viewed as a list of “bad” tests or treatments.

“This list is not intended to prohibit any particular treatment in all scenarios or dictate care decisions,” Goertz says. “It was put together as an opportunity to have an open dialogue with patients about what treatment and/or evaluation procedures may be in their best interests. It’s certainly not to be used to establish coverage decisions or exclusions.”

The ACA’s List of Chiropractic Care to Question

The ACA recommends doctors and patients discuss the necessity of the following 5 tests and procedures:

  1. In the absence of red flags, do not obtain spinal imaging (x-rays) for patients with acute low-back pain during the six weeks after the onset of pain.
    Imaging and tests do not necessarily ensure a speedy recovery; they can be expensive, and they can involve some risks to the patient in terms of radiation and also increase the likelihood of receiving surgical treatment,” Goertz says.
  1. Do not perform repeat spinal imaging to monitor patients’ progress.
    “There is currently no data available that supports the routine use of repeated x-rays in the same area of the spine when there has not been a change in diagnosis, documented worsening of symptoms, or progression of disease,” Goertz says.
  1. Avoid prolonged or ongoing use of passive or palliative physical therapy treatments (such as heat, cold, electrical stimulation, and ultrasound) for low back pain, unless they support the goal(s) of an active treatment plan.
    “[Passive therapies] can be very useful in supporting an active treatment regimen, such as preparing a patient to receive an adjustment or spinal manipulation,” Goertz says. “But they can also lead to patient inactivity, prolonged recovery, and increased cost if they are not used correctly.”
  1. Do not provide long-term pain management without psychosocial screening or assessment for possible related psychological disorders, most notably depression and anxiety.
    “There is a strong correlation between people who have been in pain for a long time and people who suffer from things such as anxiety, depression, and post-traumatic stress disorder,” Goertz says.
  1. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low back pain.
    “Lumbar supports may be of limited benefit in short run; however, the research does not support the long-term use of lumbar supports for either the treatment or prevention of low back pain,” Goertz says. “Long-term use may lead to patient inactivity and a prolonged recovery.”

Curbing Costs, Improving Care

Back and neck pain are among the most common and expensive public health issues—low back pain alone costs $200 billion a year in the United States. While the Choosing Wisely campaign hopes to cut unnecessary medical costs, the primary goal is to help patients and physicians work together to craft care plans that are individualized to the patient and set up for success. You can learn more about the ACA’s involvement in the Choosing Wisely campaign here.

Updated on: 04/22/19
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Christine Goertz, DC, PhD
Chief Executive Officer
The Spine Institute for Quality
Davenport, IA
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