March '96


Abstracts from March 1996

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Future Editions

Table of Contents / Abstracts

Subscription Information


Each quarter, Chiropractic OnLine Today will present the Table of Contents and current Abstracts from Aspen Publications' Topics in Clinical Chiropractic.

The following list comprises TICC's Editorial advisory board:


Robert D. Mootz, DC, DABCO, FICC

Associate Editors:


Daniel T. Hansen, DC, DABCO, FICC

Kevin A. McCarthy, DC, DABCO

Howard Vernon, DC, FCCS

Continuing Education Editor:

Dorrie M. Talmage, DC, DABCO

Editorial Board

Alan H. Adams, DC

Alan Breen, DC

Bernard A. Coyle, PhD

Phillip S. Ebrall, BAppSC (Chiropractic)

Gary Greenstein, DC

Warren I. Hammer, DC, MS, DABCO

Karl C. Kranz, DC

Marion McGregor, Bsc, DC, FCCS (c)

Donna M. Mannello, DC

Paul J. Osterbauer, DC, MPH

Lindsay J. Rowe, MAppSc, MD, DACBR (USA), FCCR (CAN), FACCR (AUST), FICC

Olga Rutherford, BA, Msc, PhD

Tilden H. Sokoloff, DPM, MS, DC

Thomas A. Souza, DC, CCSP

Richard D. Stonebrink, BS, DC, ND, FACO, FICC

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Future Editions

Topics in Clinical Chiropractic welcomes original scholarly manuscripts for peer review and consideration for publication. Articles relevant to topics being addressed in upcoming issues (as outlined below) will be considered. Prospective authors should submit manuscripts directly to the issue editor for a given topic or to Robert D. Mootz, DC, Associate Medical Director for Chiropractic State of Washington Department of Labor and Industries, PO Box 44321, Olympia, WA 98504-4321. Please note deadlines for receipt or completed manuscripts for each issue below. Authors are responsible for obtaining reprint permissions and paying any fees or charges for non-original charts, figures, artwork, or appendixes. For a more detailed packet of information for authors, contact Aspen Publishers, Inc., 200 Orchard Ridge Drive, Suite 200, Gaithersburg, MD 20878.

Future TICC topics:

Volume 3(4): Wellness. Strategies for chiropractic physicians providing early intervention screening will be covered in this issue. Manuscripts are sought on a variety of topics regarding disease prevention and health promotion. Topics of interest include psychologic aspects of wellness, stress reduction, and preventive and maintenance chiropractic care, among others. Those interested in submitting manuscripts should contact the issue editor as early as possible. Deadline: May 1, 1996. Issue Editor: Linda J. Bowers, Professor, Northwestern College of Chiropractic, 2501 W. 84th Street, Blooomington, MN 55431.

Volume 4(1): Pediatrics. A quality overview of key issues in chiropractic management of pediatric patients. Papers are being sought which present practical clinical insight into pediatric diagnosis, adjusting, condition specific management strategies, and balanced, critical reviews of controversial topics including the pros and cons of immunization, manipulative management of children with otitis media, etc. Given the challenging and controversial nature of these issues, potential authors should contact the issue editor before March 31, 1996 (prior to manuscript preparation) with an outline and overview of what the submission is intended to cover. Deadline: August 1, 1996. Issue Editor: Robert D. Mootz, DC, Associate Medical Director for Chiropractic, State of Washington Department of Labor and Industries, P.O. Box 44321, Olympia, WA 98504-4321.

Volume 4(2): Sports Chiropractic. A practical look at issues involved in the management of athletes. Particular emphasis is placed on incorporation of exercise and rehabilitation strategies into chiropractic practice. Management considerations in diagnosis, return to activity, and chiropractic manipulative and physiological interventions will also be highlighted. (This topic is rescheduled and modified from an earlier published call for manuscripts previously planned in Volume 4(1): Exercise and Rehabilitation.). Deadline: October 1, 1996. Issue Editor: Kevin A. McCarthy, DC, Dean of Clinics, Palmer College of Chiropractic-West, 90 E. Tasman Drive, San Jose, CA 95134.

Volume 4(3): Advances in Imaging and Special Studies. Manuscripts are sought concerning clinical utility, proper procedures, and assessment of imaging techniques and other special studies relevant to chiropractic practice. Potential authors should contact the issue editor prior to beginning manuscript preparation to avoid duplications. Deadline: January 15, 1997. Issue Editor: Daniel T. Hansen, DC, 1115 Black Lake Blvd., SW, Suite A, Olympia, WA 98502.

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Table of Contents / Abstracts for March 1996

Rocket Science, Blind Faith, or Somewhere in Between

  • Page iv: Editorial
  • Clinical Pearls

  • Page vi
  • Back to Basics: Technology Assessment of the Chiropractic Subluxation

  • Page 1: Paul J. Osterbauer
  • Decision Analysis: Are Calculations and Clinicians Really on a Collision Course?

  • Page 10: Gary D. Schultz
  • Valuation of Chiropractic Services: A Status Report and Overview of the Challenges of Standardization

  • Page 20: Robert D. Mootz and Austin D. McMillin
  • Quantitative Functional Capacity Evaluation: The Missing Link To Outcomes Assessment

  • Page 32: Steven G. Yeomans and Craig Liebensen
  • Assessment of Chiropractic Techniques and Procedures

  • Page 44: Robert Cooperstein and Michael S. Schneider
  • The Evolution of Chiropractic Research: A Foundation for Technology Assessment

  • Page 52: Donna M. Mannello, Dana J. Lawrence and Robert Mootz
  • Measuring Chiropractic Practitioner Satisfaction

  • Page 65: Ian D. Coulter, Clark D. Danielson and Ron D. Hays
  • Formal Processes in Health Care Technology Assessment: A Primer for the Chiropractic Profession

  • Page 71: Daniel T. Hansen and Robert D. Mootz
  • Appendixes: Algorithms, Forms, and Other Clinical Aids Related to the Articles in this Issue

  • Page 84
  • Continuing Education Credit

  • Page 95

  • Back to basics:

    Technology Assessment of the Chiropractic Subluxation

  • Paul J. Osterbauer, DC, MPH:
    Director of Research Activator Methods, Inc., Phoenix, Arizona
  • Overview: The Chiropractic concept of vertebral subluxation has served the purpose of unifying early DCs by contrasting a unique approach to health problems offered by chiropractors to allopathic medicine. However, confusion over the use of this term, and the concepts surrounding it, has existed because of a lack of consensus among chiropractors. A variety of methods has been offered to identify and measure the effects of vertebral subluxation in order to provide evidence regarding its existence. How the chiropractic profession deals with its belief systems and model building in this era of increasing accountability may be more important than the search for the subluxation itself. Approach: In order to assist practitioners to cope with this dilemma, an overview of selected subluxation assessment procedures is provided including a qualitative review of relevant studies examining reliability and validity of the various approaches. Criteria for assessing technology are presented, and recommendations are made regarding the value of a number of currently available assessment strategies. A discussion of future technology assessment issues is offered. Key words: biomechanics; chiropractic; physical examination; range of motion (articular); technology assessment (biomedical)

    Decision Analysis: Are Calculations and Clinicians Really on a Collision Course?

  • Gary D. Schultz, DC, DACBR
    Associate Professor; department of Radiology LACC; Whittier, California
  • Purpose: The practicing doctor has been, and always will be, faced with uncertainty in the clinical setting. Recent times have seen this fact complicated by a drive for more accountability in how that uncertainty is managed. Understanding the purpose of decision analysis processes is an important prerequisite to successful implementation in day-to-day practice. Applying decision analysis principles in practice holds benefits including greater clinical acumen and improved documentation for decisions that are made. In the long run, implementing decision analysis can improve clinical and production efficiency in the office setting and optimize care to the patient. Approach: This article focuses on the environment in which clinical decisions are made and how implementation of one decision analysis method (the Bayesian model) can assist the practitioner in best managing uncertainty and documenting the decisions made on behalf of the patient. The article is introductory in scope, appealing more to those unfamiliar with formal statistical methods of decision processing than with the decision analysis devotee. Conclusion: Use of decision analysis need not be a rigorous mathematical exercise to be helpful in everyday clinical practice. Key words: algorithms; data interpretation (statistical); decision making; predictive value of tests; technology assessment (biomedical)

    Valuation of Chiropractic Services: A Status Report and Overview of the Challenges of Standardization

  • Robert D. Mootz, DC, DABCO, FICC
    Associate Medical Director for Chiropractic State of Washington Department of Labor and Industries; Olympia, Washington

  • Jennifer A. Hess, DC
    Graduate Student; University of Washington School of Public Health ; Private Practice; Oak Harbor, Washington

  • Austin D. McMillin, DC
    Chair, Coding Committee; Washington State Chiropractic Association; Private Practice; Tacoma, Washington
  • Purpose: A review of issues involved in the development of resource-based relative value scales for physician reimbursement is provided. A brief discussion of the current process in use for developing and determining economic values for clinical services is included, along with a discussion of where chiropractic procedures fit into this process. Methodology: Preliminary demographic data from a random national survey of practicing chiropractors on salary levels, postgraduate certification , and range of techniques is reported. A summary of a recent national consensus panel examining the relative work value for chiropractic manipulation therapy is contrasted with existing relative work values for current coding options. Conclusions: There are multiple remaining reimbursement issues that such valuation processes have on chiropractors given changes occurring in health services reimbursement. Key words: consensus development conferences; health policy; manipulation (orthopaedic); relative value scales; reimbursement mechanism

    Quantitative Functional Capacity Evaluation: The Missing Link To Outcomes Assessment

  • Steven G. Yeomans, DC, DABCO
    Private Practice; Ripon, Wisconsin

  • Craig Liebensen, DC
    Private Practice; Santa Monica, California
  • Purpose: Both subjective and objective approaches to outcomes assessment are reviewed and discussed. Five criteria for the development of an instrument are offered, and a comparison of high-versus low-tech functional testing is made. Utilization parameters with risk factors for chronicity are also discussed. Methods: A qualitative literature review was performed searching for functional tests which have been found valid and reliable. Tests which included a normative database were selected. After collection of the tests, the most user friendly and valid/reliable were grouped together. Results: A functional capacity evaluation approach using low-tech, low-cost tests were collectively grouped together and called the quantitative functional capacity evaluation (QFCE). Each test is listed and includes the procedure, the normative data, and the various references reviewed. Discussion: The utility, the goals, and the clinical application of the QFCE are discussed. The use of the normative data and pre-/posttest result comparisons are discussed for reasons of documentation, insurance communication, and steering the rehabilitation goals and patient education. Key words: disability evaluation; outcome assessment; range of motion (articular); rehabilitation; work capacity evaluation

    Assessment of Chiropractic Techniques and Procedures

  • Robert Cooperstein, DC
    Associate Professor; Palmer College of Chiropractic-West; San Jose, California

  • Michael S. Schneider, DC
    Private Practice of Chiropractic; Pittsburgh, Pennsylvania
  • Overview: Technology assessment is a form of policy research that evaluates procedures, devices, and protocols that impact decision makers’ choices for health care purchasing. Teaching hospitals, universities, surgical suppliers, drug companies, and managed care organizations have been taking steps to incorporate technology assessments of medical procedures as routine components of their course of operation. In chiropractic, determination of who performs technology assessments, where they are done, and how they are financed is more ambiguous. Approach: An overview and inventory of prior efforts at technology assessment within chiropractic are presented. A discussion of the roles played by chiropractic colleges, intercollegiate collaborations, technique entrepreneurs, and managed care organization is offered. Conclusions: The chiropractic profession is enjoying some enhanced credibility and acceptance as a result of several recent technology assessment efforts. However, greater pressure and increased competition will likely require greater effort and enhance means for implementing evidence-driven modifications in clinical practices. Key words: chiropractic; entrepreneurship; manipulation (orthopaedic); process assessment; technology assessment (biomedical)

    The Evolution of Chiropractic Research: A Foundation for Technology Assessment

  • Donna M. Mannello, DC
    Associate Professor; Logan College of Chiropractic; St. Louis, Missouri

  • Dana J. Lawrence, DC, FICC
    Editor, Journal of Manipulative and Physiological Therapeutics Director, Department of Publication and Editorial Review; National College of Chiropractic; Lombard, Illinois

  • Robert D. Mootz, DC, DABCO, FICC
    Associate Medical Director for Chiropractic; State of Washington Department of Labor and Industries; Olympia, Washington
  • Overview: A qualitative overview of the evolution and significance of chiropractic research is presented. The development of the chiropractic research enterprise demonstrates the strength and determination to overcome internal and external impediments involving belief systems, political ostracism, and severely limited resources. The accomplishments can be attributed to a relatively small number of individuals. Many methods employed by chiropractors have increasingly passed the test of critical scientific scrutiny contributing to an authoritative position in the care of patients with a number of neuromusculoskeletal conditions. Approach: A discussion of the demands to further evaluate chiropractic methods is offered along with a review of types of research designs, how to read and understand the clinical and scientific literature, and the appropriate role research has within the chiropractic profession. Summary: Examples of recent and current chiropractic research efforts are outlined, and the need for continued effort is discussed. Key words: chiropractic; health services research; literature; peer-review (research); publishing; writing

    Measuring Chiropractic Satisfaction

  • Ian D. Coulter, PHD
    RAND, Santa Monica, California; LACC, Whittier, California; UCLA School of Dentistry, Los Angeles, California

  • Clark D. Danielson, MPA
    LACC, Whitttier, California

  • Ron D. Hays, Ph.D.
    RAND, Santa Monica, California; UCLA School of Dentistry, Los Angeles, California
  • Purpose: Survey research was conducted to assess chiropractic practitioner satisfaction. Methods: A 13-item practitioner satisfaction questionnaire, adapted from a dental instrument, was given to 44 randomly chosen chiropractors in Los Angeles. The item content includes income, professional relations, professional time, patient relations, practice management, personal time, professional environment, respect, job stress, and delivery of care. Results: The results show that the chiropractors had a relatively high level of practice satisfaction. This finding compares with a very high level of patient satisfaction for the same practitioners. Key words: job satisfaction; patient satisfaction; physician-patient relations; quality assurance (health care); questionnaires

    Formal Process in Health Care Technology Assessment: A Primer for the Chiropractic Profession

  • Daniel T. Hansen, DC, DABCO, FICC
    Private Practice, Olympia, Washington

  • Robert D. Mootz, DC, DABCO, FICC
    Associate Medical Director for Chiropractic, State of Washington Department of Labor and Industries, Olympia, Washington
  • Purpose: As chiropractic finds increasing public acceptance in health services and reimbursement, a commensurate increase in requirements for proper assessment of chiropractic technologies and procedures, along with documentation of appropriate guidelines for care, is occurring. This article reviews the nature of technology assessment (TA) and examines how TA is affecting individual DCs and the profession as a whole. Methods: A qualitative review of selected, relevant TA literature was performed. Background information about recognized organizations addressing technology assessment issues was gathered. From this process, an overview was synthesized regarding issues confronting the chiropractic profession. Conclusions: Academic, scientific, clinical, and political leaders in the profession acknowledge the need for appropriate methods of technology assessment and guideline development. There is some evidence of advancing efforts in proper assessment of technologies found in chiropractic practices. A trend toward patient-centered values in health knowledge of individual delivery is stimulating some changes in formal technology assessment sequences. It is recommended that the knowledge of individual practitioners regarding TA processes be enhanced and that more and different constituencies take responsibility for advancing that knowledge. Key words: practice guidelines; process assessment (health care); quality assurance (health care); quality of health care

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    Topics in Clinical Chiropractic is published quarterly, for $58, by Aspen Publishers.

    Aspen may be contacted directly at: 800-638-8437

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