EBP and Chiropractic

CHeck out this link to EBP seminar for Chiros

http://www.chiropractic.org/index.php?p=news/evidence_seminar

Check out the program and see if you can determine the EBP aspect of the seminar - talk about using a buzzword to get attention instead of having substance!

Jeff

Comments

[John Ware]

Jeff,
Thanks for this lastest example of chiropractic "spin" of the term "evidence-based." I recently participated in a long thread on this blog (September 06, 2006
"A Chiropractic Perspective"), which included a couple of DC's who claimed to be evidence-based practictioners. To sum up my take: I can't understand how someone can practice EBM when the foundational theory of their profession has absolutely no basis in evidence. To me the terms chiropractic and EBM are antithetical. But, as the course you site indicates, chiros are not above taking the term and twisting it to suit their needs and jump aboard the "EBM Express".

Mike Schneider, DC made a compelling argument for cooperation between PT's and DC's to spell out legislative language that would allow us both to perform manipulation. I countered that I would not be inclined to participate in a cooperative effort with DC's basically because I don't trust them. This course ad you site is a perfect example of why the chiros are not trustworthy.
John

[Eric]

Jeff, I am a little disappointed in your bias against the chiropractic profession. If there was no science based on the treatment given, it should have parished by the side of the road. But, you know as well as I know there is plenty of science backing up what the chiropractic profession provides in treatment. Manipulation, physical therapy modalities (passsive and active), motion of the joints, etc... Just because there are some chiropractic doctors that are "bad apples" does not mean that all are bad. Just like those in the PT arena. There are those that try to take advantage of the system for one purpose only and that is money. John, I am sorry that you have had bad experiences with chiropractors. I know many chiropractors that are evidence based medicine practictioners and are great clinicians and do a great service. We could all vent our perspectives on our professions and those leaders. I am a chiropractor and I think highly of those in the PT profession and until they prove otherwise they are a great asset to the healthcare community. We could banter back and forth about our individual professional weaknesses. John, please if you need a good reference to a chiropractor in your area I would be pleased to help you out. In conclusion, please don't judge the entire profession for a few idiots. My email address is erict33@msn.com

[Fred Deutsch, DC]

Jeff, John & other Contributors:
Let's call a spade a spade. It is true that some chiropractors are quacks just as it is true that some physical therapists are quacks. To not trust all providers of a given profession because of your experience with a few, with all due respect, smacks of prejudice. (Definition: 1. A preformed opinion, usually an unfavorable one, based on insufficient knowledge, irrational feelings, or inaccurate stereotypes. 2. An unfounded hatred, fear, or mistrust or a person or group). Instead of making blanket statements that you "would not be inclined to participate in a cooperative effort with DC's basically because I don't trust them," may I suggest you attempt to expand your horizons for the benefit of your patients? Do you trust ALL medical physicians? Do you trust ALL physical therapists? Are there some physicians that you have a hard time working with, for one reason or another? Are there some physical therapists that make their living entirely in the world of passive care, that professionally embarrass you, that you wish never went into the profession? I feel that way about some of my chiropractor colleagues.

That being said, I have great respect and admiration for others in my profession – those that work tirelessly to work for the same things that quality physical therapists work for. To ignore or despise the fact that many physical therapists, chiropractors and medical physicians work together cooperatively for the benefit of the patient is to hold yourself to a lower standard of professionalism, in my humble opinion, and is to deny your patient one potentially valuable avenue of therapeutic benefit. Many PTs, DCs, and MDs work together, even in the same facility, because all parties recognize they don't hold the single key to solve patient problems. As just a few examples, check out the Rehabilitation Institute of Chicago -- or the Texas Back Institute. Google these facilities and you'll see chiropractic divisions -- chiropractors working with physical therapists and medical spine or rehabilitation specialists. If some of the most respected physical medicine institutes in the country trust the development and incorporation of clinical relationships with chiropractors, perhaps it may behoove others to at least have an open mind that there may be benefit to doing the same?
Fred Deutsch, DC

[Jeff Hathaway]

Gentlemen

I beleive my intent here is being misconstrued. My intent was to point out how EBP was being "used" improperly by other professions as it is in PT - not a direct bash on the DC profession. I have had close association with DC's in the past and have even spoken at a DC seminar. I have seen first hand the various factions within the DC profession and admit there have been PT's who I would not stand tall with.
I see this movement toward EBP as an opportunity within my profession to correct ills that exist.

Generalities and stereotypes are rarely useful and were not an intended part of my original comment. As I was once told - "When you judge others you define yourself."
Jeff

[jame smith]

Good point Jeff. It is going to take a very long time, huge committment, and immense rescources for EBP to evolve enough to correct the multitude of ills in all aspects of medical practice as it exists today. I think the "telltale" of our professional maturity is if we patiently develope and use EBP as a tool of change as opposed to wielding it like a club.

[John Ware]

Fred,
To conclude that I do not trust all chiropractors based on my previous comment is fallacious reasoning. I will expound on my previous comment regarding my distrust of the chiropractic profession in order to clarify my position.
PT's are currently, and have been as long as I've been practicing (12 years), under hostile assault from chiropractic organizations to restrict our right to perform manipulation. Bogus arguments have been made by chiropractic organizations based on public health concerns to infringe on our right to perform manipulation. They have no facts to back up the claims of risk to the public health, while we have ample evidence to prove that no such increased risk exists (see "Direct Access: Where's the Beef? The Challenge from the Chiropractors" by William Boissonnault in Ariculations, vol. 12, no. 2). Yet, the lawsuits keep coming from state chiropractic boards across the country. We realize that the chiropractic organizations see the scientific advancement of movement science under PT scholars and clinicians as a threat to their very existence. Many DC's are realizing this as well and are pursuing further degrees in rehabilitation sciences and even DPT's.
So, my gripe is not so much with Dr. Backcracker down the street as much as it is with the chiropractic organizations and associations that continue to come after my right to perform an essential function of my profession. I'm just not convinced that the leadership of these chiro groups would negotiate in good faith once "cooperation" reached that level. On the other hand, I'm not against discussing the issue with reasonable- and honest- chiropractors in forums like this.
The ad Jeff cited was prominent on the home page of the International Chiropractic Association. I don't know if this is a reputable organization within chiropractic, but it is a prime example of misuse of the term "evidence-based." Any reputable organization should not allow it to be used in this way, as it diminishes the integrity of the organization and the profession it claims to represent.
John

[Michael Schneider]

To All,

Unlike the PT profession, which has one national association, the APTA...chiropractic has at least two national assocations...the American Chiropractic Association (ACA) and the International Chiropractic Association (ICA). The ICA is the smaller of the two associations, and represents only a fraction of the chiros in the U.S. The ICA promotes a model of subluxation based wellness chiropractic, which is one of the four models I presented in my opening post to this blog.

As such, you must take anything the ICA says or promotes with a grain of salt, knowing that their ideas only represent a true minority of the collective chiropractic mindset.

Yet, this ad is still very troubling. It is an attempt to use the buzz word "Evidence Based Practice" to promote a version of chiropractic that is NOT evidence based. There are many of us DCs who are truly evidence based who despise this sort of "gaming the system"...but we have no influence over the ICA leadership or membership.

There is certainly a schism in chiropractic, as shown by the presence of two competing national chiropractic associations with different views of the profession. This schism has persisted for at least 50 years, and shows no signs of letting up.

John states that the terms chiropractic and EBM are antithetical. I would rephrase that comment to state subluxation-based wellness chiropractic and EBM are antithetical. Or to be more blunt...the ICA version of chiropractic is not evidence based.

The practice of spinal manipulation in the USA is largely on the map because of DCs. Until the AHCPR guidelines were published in 1994 with the strong statement that spinal manipulation was the treatment of choice for acute LBP, there was only minor interest in spinal manipulation outside of chiropractic. Those guidelines downplayed the role of other physiotherapeutic modalities.

So, are the terms spinal manipulation for LBP and EBM antithetical? Surely this is a simplistic way to reason out this issue.

The real issue brought up by this miserable ad promoted by the ICA chiros is one of public trust. In this regard I agree with John, this DC is not to be trusted. But he does not represent the entire chiropractic profession.

I am going to take action on this issue. I will circulate this ad on another chiropractic list which has evidence based DCs only, and suggest that all members of the list write letters of complaint to the ICA and the DC promoting this twisted version of an EBM course. We will specifically ask them to cite which specific sources of evidence this course is based upon, and what references are provided with the course hand-out.

I do not know what (if anything) will happen when a number of DCs write letters of complaint...but it will be worth the effort. If anyone is interested, I will post the outcome of the letter writing campaign on a future post.

Mike Schneider, DC

[Dr. Eric Tondera]

John, it appears that we seem to all agree that there are doctors and PTs out there that are not quality. But, I must admit sitting on this side of the street, it does not appear to be all one sided on the issue of limiting scope of the PTs. I in Texas have been on the defensive side of what the PT organization have been trying to limit the scope of the chiropractors. It goes back to the same ole thing, money. All our organizations are trying to protect the rights we have and expand other rights. Remember chiros have been doing passive and active modalities longer than the PTs have been performing those therapies. I am not saying that we do it better or you all do it better. What I am saying is that we chiropractors are limited in our word choice due to the limiting regulations of the PT organizations. These limiting positions are also being aggressively brought on by the PT organizations in Texas even today. So, again may I point out it is not just one sided problem we are all commenting on. It is obvious to me that the turf war between all the professions (MD, PT and DC) are not helping anyone but hurting the overall practice of physical medicine. Some are going to be better at it due to their training, education and practice. Through some of my friends and family that are PTs it is very clear that PTs have a greater education on some aspects of physical medicine, but in other regions are very limited. This goes both ways. DCs are also more educated and trained in some regions of physical medicine but in other regions we have very little understanding. Why don't we chastise those that are creating the term quack in all the health professions. It is sad that there are state and national boards that are suppose to take care of this policing, but we all agree that they don't have teeth to make a dent in a baby's butt, much less take a license from those who are dangerous or practice in such a way that make us all look bad. Thanks for allowing me to participate with you all in comments to help us all.

[John Ware]

Eric,
I think you're making some generalizations without specific examples to support them. You state that chiros have been performing "passive and active modalities" longer than PT's. I don't know that this is true across the board. I know that chiros have been around longer than PT's, but I'm fairly certain that your colleagues haven't been performing wound care with electrical stimulation or hydrotherapy. Furthermore, I can't recall seeing any peer-reviewed research on the the effects of ultrasound on collagen or electrical stimulation for muscle strengthening by chiropractors. In fact, I'm not sure what you mean by "passive and active modalities."
I don't know what's going on it Texas, but in the several states where I have practiced physical therapy, the only term we have limited anyone else from using is "Physical Therapy." Don't your think it's reasonable for us to limit the use of the name of our profession to those who hold the license to practice it? I shudder to think how the chiros would react if I were to run a full page ad in the yellow pages stating that I performed manual therapy techniques-including chiropractic manipulations! (For the record, there are 3 ads in my local yellow pages where chiropractors illegally use the term "physical therapy," there are no ads where PT's perform "chiropractic" anything).
Finally, I don't consider myself a practitioner of "physical medicine," so I don't know how I could be educated in something that I am not. I'm a physical therapist. The foundational theory of my practice is based in human movement science. I use a variety of traditional and evidenced-based interventions ("passive and active modalities"?) in order to help my patients achieve their goals toward as close to normal function with as little pain as possible. This is what all PT's do, whether the pt has a brain injury, a torn ACL, a decubitus sore on their sacrum-or, yes, even acute LBP.
I appreciate your comments, but please be specific.
John

[Sean]

John,
I am in Texas and I believe he is referring to chiros being slowly phased out of the workers comp system; not by PT's but by the state organization who realized there was a ton of fraud and overutilization occurring under some chiros care.
In Texas, the only group fighting against a limitation of scope of practice is PT's. At the same time athletic trainers and massage people want to throw their hats into the ring and infringe on our practice.