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Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial

Abstract


Objective

The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache.

Methods

A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed.

Results

All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01).

Conclusions

Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

 

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Manipulation Under Anesthesia for Lumbopelvic Pain: A Retrospective Review of 18 Cases

Abstract


Objective

The purpose of this case series is to report the effects of manipulation under anesthesia (MUA) for patients with lumbopelvic (lumbar spine, sacroiliac and/or pelvic, hip) pain in an outpatient ambulatory/hospital-based setting.

Methods

A retrospective chart review of cases treated at an outpatient ambulatory surgical center in New York and a general hospital in New York was performed. Patients with pre- and postintervention Oswestry Low Back Pain Disability Index (ODI) scores and lumbopelvic and hip complaints were included (N = 18). No intervention other than MUA was administered between the initial and follow-up ODI scoring. Scores on the ODI were assessed within 1 week prior to MUA and again within 2 weeks postprocedure.

Results

Patients underwent 2 to 4 chiropractic MUA procedures over the course of 7 to 8 days as per National Academy of Manipulation Under Anesthesia physicians' protocols. Preprocedure ODI scores ranged from 38 to 76, with an average score of 53.4. Postprocedure scores ranged from 0 to 66, with an average score of 32.8. For each patient, ODI scores were lower after MUA, with an average decrease of 20.6. Sixteen of 18 patients experienced a clinically meaningful improvement in ODI score. No adverse reactions were reported.

Conclusions

For 16 of the 18 patients with chronic lumbopelvic pain reported in this study, MUA showed clinically meaningful reduction in low back pain disability.

 

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Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome: A Case Report

Abstract


Objective

The purpose of this case report is to describe multimodal chiropractic care of a female patient diagnosed with benign joint hypermobility syndrome (BJHS) and a history of chronic spine pain.

Clinical features

A 23-year-old white female presented for chiropractic care with chronic low back pain, neck pain, and headaches. The patient was diagnosed with BJHS, including joint hypermobility of her thumbs, elbows, right knee, and lumbopelvic region. A 6-year history of low back pain and varicose veins in her posterior thighs and knees were additional significant diagnostic findings of BJHS.

Interventions and outcomes

The treatment consisted of spinal and extremity manipulation, Graston technique, and postisometric relaxation combined with sensory motor stimulation and scapular stabilization exercises. The patient was seen 15 times over an 18-week period. After 18 weeks of care, the Revised Oswestry Low Back Questionnaire and Headache Disability Index demonstrated clinically important improvements with her low back pain and headache; but little change was noted in her neck pain as measured by the Neck Disability Index.

Conclusion

This patient with BJHS who had decreased disability and spine pain improved after a course of multimodal chiropractic care.

 

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Presentation of an 85-Year-Old Woman With Musculoskeletal Pain to a Chiropractic Clinic: A Case of Ischemic Stroke

Abstract


Objective

The purpose of this case is to describe a patient who had a stroke preceding a chiropractic appointment and was unaware that the cerebrovascular event had occurred.

Clinical features

An 85-year-old established patient presented for chiropractic treatment of pain in the left side of the neck, hip, and low back associated with known advanced degenerative spinal disease and lumbar stenosis. On the day of presentation, the patient reported morning nausea, double vision, and right-sided vision loss; she related that she had collided into a car while driving to the appointment. Review of her medical history divulged residual neurological deficits related to a previous subdural hematoma, resulting in craniotomy. Examination revealed a right inferior quadrantanopia in the right eye and right nasal hemianopia in the left eye. Nystagmus was present in the left eye with saccadic intrusion on pursuit right to left.

Intervention and outcome

The patient was transported immediately to an emergency room,where diagnosis of an Acute infarct in the left cerebrum at the junction of the left occipital, parietal and temporal lobes in the watershed area was confirmed.

Conclusion

Patients with signs and symptoms of stroke in progress may occasionally present for chiropractic care. It is imperative to complete a thorough history and examination prior to care.

 

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A Collaborative Approach Between Chiropractic and Dentistry to Address Temporomandibular Dysfunction: A Case Report

Abstract


Objective

The purpose of this case report is to describe the chiropractic and dental comanagement of a patient with temporomandibular dysfunction, headaches, and myalgia.

Clinical features

A 38-year-old black female patient presented for chiropractic care with a chief concern of jaw pain, tinnitus, headaches, and neck and shoulder soreness of 8 months’ duration. The patient rated the pain a 6/10. The patient had a maximum mouth opening of 42 mm, graphed evidence of disk displacement, loss of translation on opening of the right temporomandibular joint viewed on the lateral radiograph, and numerous areas of point tenderness on the Kinnie-Funt Chief Complaint Visual Index. She had decreased lateral cervical flexion.

Intervention and outcome

Dental treatment consisted of an anterior repositioning splint. Chiropractic care consisted of Activator treatment to the pelvis and the thoracic and cervical spine. Manual manipulation of the temporomandibular joint was performed along with a soft tissue technique intraorally on the lateral pterygoid. Postisometric relaxation in the head and neck region was also done. The patient was treated 6 times over 3 weeks. At the end of treatment, the patient had a pain rating of 0/10, maximum mouth opening of 49 mm, no tender points on the follow-up Kinnie-Funt, and increased cervical range of motion.

Conclusion

The patient demonstrated increased mouth opening, decreased pain rating, improved Kinnie-Funt visual index, and an increased cervical lateral flexion range of motion after 3 weeks of a combination of chiropractic and dental care.

 

Source

Case Report: A Patient with Low Back Pain and Somatic Referred Pain Concomitant with Intermittent Claudication in a Chiropractic Practice

Abstract


Introduction

Approximately 12% of older patients in the general population have atherosclerotic disease of the aorta and lower extremity arteries, i.e., peripheral artery disease (PAD). Intermittent claudication is the most common symptom. When a patient with low back pain complains of lower extremity pain that is worsened with mild exercise (e.g. walking), the etiology is often not clear.

Case Presentation

A 56 year-old male presented with low back pain, left hip and buttock discomfort, numbness in thigh and calf, and left knee weakness while walking.

Intervention and Outcome

Chiropractic care was provided and the low back pain improved. The patient developed leg weakness. Radiographic evaluation showed calcification of abdominal aorta and common iliac arteries. The patient was referred for medical evaluation and diagnostic ultrasound findings of arterial occlusion lead to surgical referral. The surgeon reported a “significant amount” of blockage of the left external iliac artery. Leg weakness resolved following placement of surgical stents.

Discussion

Claudication may go undiagnosed because many people consider the pain a consequence of aging, and may therefore just reduce their activity level to avoid the pain. Early diagnosis of PAD/intermittent claudication is important since PAD is a major risk factor for adverse cardiovascular events.

Conclusion

Patient management in the chiropractic clinical setting required appropriate medical referral in this case. Surgical implantation of stents in the left external iliac artery resolved the complaint of leg weakness. It is imperative for health care professionals to have awareness of the high occurrence of PAD in the general population.

 

A survey of "mental hardiness" and "mental toughness" in professional male football players

Abstract (provisional)


Background

It is not uncommon for chiropractors to be associated with sports teams for injury prevention, treatment, or performance enhancement. There is increasing acceptance of the importance of sports psychology in the overall management of athletes. Recent findings indicate mental hardiness can be determined reliably using specific self-assessment questionnaires. This study set out to investigate the hardiness scores of professional footballers and examine the correlation between two questionnaires. It also included a mental hardiness rating of players by two coaches, and examined differences in hardiness and mental toughness between national and international players.

Methods

Two self-assessment questionnaires (modified Sports Mental Toughness Questionnaire [SMTQ-M] and Psychological Performance Inventory [PPI-A] ) were completed by 20 male professional footballers. Two coaches, independently rated each player. A percentage score from each questionnaire was awarded each player and an average score was calculated ({SMTQ-M % + PPI-A %} / 2). The PPI-A and SMTQ-M scores obtained for each player were analysed for correlation with Pearson's correlation coefficient. Cohen's kappa inter-reliability coefficient was used to determine agreement between coaches, and between the players' hardiness scores and coaches' ratings. The independent t-test was used to examine differences between national and international players.

Results

The players' scores obtained from PPI-A and SMTQ-M correlated well (r = 0.709, p < 0.001). The coaches ratings showed significant, weak to moderate agreement (Cohen's kappa = 0.33). No significant agreement was found between player self-assessments and coaches' ratings.

The average ({SMTQ-M % + PPI-A %} / 2) mean score was 77 % (SD = 7.98) with international players scoring 7.4 % (p = 0.04) higher than non-international players.

Conclusions

The questionnaires (SMTQ-M and PPI-A) correlated well in their outcome scores. These findings suggest that coaches moderately agree when assessing the level of mental hardiness of football players. There was no agreement between player self-assessment and ratings by coaches. Footballers who play or had played for national teams achieved slightly higher mental hardiness scores.

Either questionnaire can offer the clinician a cost-effective, valuable measure of an individual's psychological attributes, which could be relevant within the wider context of bio-psycho-social model of care.

 

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The role of information search in seeking alternative treatment for back pain: a qualitative analysis

Abstract (provisional)


Background

Health consumers have moved away from a reliance on medical practitioner advice to more independent decision processes and so their information search processes have subsequently widened. This study examined how persons with back pain searched for alternative treatment types and service providers. That is, what information do they seek and how; what sources do they use and why; and by what means do they search for it?

Methods

12 persons with back pain were interviewed. The method used was convergent interviewing. This involved a series of semi-structured questions to obtain open-ended answers. The interviewer analysed the responses and refined the questions after each interview, to converge on the dominant factors influencing decisions about treatment patterns.

Results

Persons with back pain mainly search their memories and use word of mouth (their doctor and friends) for information about potential treatments and service providers. Their search is generally limited due to personal, provider-related and information-supply reasons. However, they did want in-depth information about the alternative treatments and providers in an attempt to establish apriori their efficacy in treating their specific back problems. They searched different sources depending on the type of information they required.

Conclusions

The findings differ from previous studies about the types of information health consumers require when searching for information about alternative or mainstream healthcare services. The results have identified for the first time that limited information availability was only one of three categories of reasons identified about why persons with back pain do not search for more information particularly from external non-personal sources.

 

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Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up

Abstract (provisional)


Background

Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome.

Methods

Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.

Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.

The patient's global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of 'better or 'much better' were categorized as 'improved'.

The proportion of patients 'improved' at each time point was calculated. Chi-squared test compared subgroups with 'improvement'. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.

Results

52% of 115 recruited patients 'improved' at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to [single low-9 quotation mark]improvement' when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).

Conclusions

Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of[single low-9 quotation mark] improvement' in the logistic regression model

 

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Radial neck fracture presenting to a Chiropractic clinic: a case report and literature review

Abstract (provisional)


Objective

The purpose of this case report is to describe a patient that presented with a Mason type II radial neck fracture approximately three weeks following a traumatic injury.

Clinical features

A 59-year old female presented to a chiropractic practice with complaints of left lateral elbow pain distal to the lateral epicondyle of the humerus and pain provocation with pronation, supination and weight bearing. The complaint originated three weeks prior following a fall on her left elbow while hiking.

Intervention and outcome

Plain film radiographs of the left elbow and forearm revealed a transverse fracture of the radial neck with 2mm displacement--classified as a Mason Type II fracture. The patient was referred for medical follow-up with an orthopedist.

Conclusion

This report discusses triage of an elbow fracture presenting to a chiropractic clinic. This case study demonstrates the thorough clinical examination, imaging and decision making that assisted in appropriate patient diagnosis and management.

 

Source

Management of patients with low back pain: a survey of French chiropractors

Abstract (provisional)


Background

Little is known about the level of consensus within the French chiropractic profession regarding management of clinical issues. A previous Swedish study showed that chiropractors agreed relatively well on the management strategy for nine low back pain scenarios. We wished to investigate whether those findings could be reproduced among French chiropractors.

Objectives

1. To assess the level of consensus among French chiropractors regarding management strategies for nine different scenarios of low back pain. 2. To assess whether the management choices of the French chiropractors appeared reasonable for the low back pain scenarios. 3. To compare French management patterns with those described in the previous survey of Swedish chiropractors.

Method

A postal questionnaire was sent to a randomly selected sample of 167 French chiropractors in 2009. The questionnaire described a 40-year old man with low back pain, and presented nine hypothetical short-term outcome scenarios and six possible management strategies. For each of the nine scenarios, participants were asked to choose the management strategy that they would recommend. The percentages of respondents choosing the different management strategies were identified for each scenario. Appropriateness of the chosen management strategy was assessed using predetermined ?best practice? for each scenario. Consensus was arbitrarily defined as ?moderate? when 50- 69% of respondents agreed on the same management choice for a scenario, and ?excellent? when 70% or more provided the same answer.

Results

Excellent consensus was achieved for only one scenario, and moderate consensus for two scenarios. For five of the nine scenarios, the most common answers were in agreement with the ?best practice? management strategies. Consensus between the French and Swedish responses on the most appropriate management was seen in five of the nine scenarios and these were all in agreement with the expected answer.

Conclusion

There was reasonable consensus among the French chiropractors in their choice of treatment strategy for low back pain and choices were generally in line with ?best practice?. The differences in response between the French and Swedish chiropractors suggest that cultural and/or educational differences influence the conceptual framework within which chiropractors practice.

 

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Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report

Abstract (provisional)


Background

This systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions/interventions that received an 'inconclusive? or 'negative? evidence rating or were not covered in the report.

Methods

A literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added.

Results

25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were randomised controlled trials, and 10 were non-randomised primary studies. Most 'inconclusive? or 'moderate? evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation/mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive.

Conclusions

Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.

 

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Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey

Abstract (provisional)


Background

Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens. Aim To describe the utilization of interventions in patients with neck pain by clinicians.

Methods

A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain.

Results

The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and `other? interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics).

Conclusions

This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective.

 

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The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain

Abstract


Background

Several tests have been suggested to assess the isometric endurance of the cervical flexor (NFME) and extensors (NEE) muscles. This study proposes to determine whether neck flexors endurance is related to extensor endurance, and whether cervical muscle endurance is related to disability, pain amount and pain stage in subjects with neck pain.

Methods

Thirty subjects (18 women, 12 men, mean ± SD age: 43 ± 12 years) complaining of neck pain filled out the Visual Analogue Scale (VAS) and the Neck Pain and Disability Scale-Italian version (NPDS-I). They also completed the timed endurance tests for the cervical muscles.

Results

The mean endurance was 246.7 ± 150 seconds for the NEE test, and 44.9 ± 25.3 seconds for the NMFE test. A significant correlation was found between the results of these two tests (r = 0.52, p = 0.003). A positive relationship was also found between VAS and NPDS-I (r = 0.549, p = 0.002). The endurance rates were similar for acute/subacute and chronic subjects, whereas males demonstrated significantly higher values compared to females in NFME test.

Conclusions

These findings suggest that neck flexors and extensors endurance are correlated and that the cervical endurance is not significantly altered by the duration of symptoms in subjects with neck pain.

 

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VBA Stroke: Resources for Doctors of Chiropractic

There is growing interest in the association between cervical manipulation and vertebrobasilar artery (VBA) stroke. Unfortunately, opinion rather than fact has often dominated discussions on this topic, even though there has been no definitive evidence that cervical adjustments can cause a stroke. ACA is sensitive to the public‘s concerns surrounding this complex issue, and is offering the following resources to help state associations and doctors of chiropractic disseminate accurate information about the risks of serious injury following cervical manipulation.

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ACA Honors Exceptional Service with 2014 Annual Awards

 

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American Chiropractic Association Adopts Summit's "Drug-Free Approach" to Health Care

Washington, D.C.--The American Chiropractic Association's (ACA) House of Delegates (HOD) today adopted language describing the profession's approach to health care and the use of drugs by chiropractic physicians during it's annual meeting Feb. 28- March 1 in Washington, D.C.

The statement was originally written and approved by the Chiropractic Summit, an umbrella leadership group of more than 40 prominent chiropractic organizations, during a meeting in Seattle in November.

The statement reads, in part--
Summit Promotes Drug-Free Approach:

"The drug issue is a non-issue because no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care."
As you can imagine, this statement was crafted very carefully and after long discussions by all participants of the Summit, which includes organizations and individuals from all corners of the profession and with widely varying viewpoints. When the group first approached the task, it realized that the profession could not legitimately use the word "drugless" to describe itself. Surprised? It makes sense when you consider the FDA classifies the use of certain vitamins and supplements to treat a condition a form of drug use. With so many doctors of chiropractic using nutritional therapy to help their patients, it was obvious to even the most conservative among us that "drug-free approach" more accurately describes what we all do.

Granted, there are wide variations in the scope of practice for chiropractic based on the state in which DCs practice. Some states are quite expansive in what they allow doctors of chiropractic to do; others are rather restrictive. The Summit's role is not to define scope (that is the function of the states themselves), so any statement on chiropractic practice drafted-to be accurate-needed to keep into account those who may have more tools in their toolbox.

Nevertheless, the approach that all doctors of chiropractic take, regardless of their available tools for patient care, is first and foremost drug-free. This is what unites us; we as a profession can be proud that the organizations representing the Chiropractic Summit came together and unanimously agreed on this very positive and powerful statement.

"ACA is proud to adopt the Chiropractic Summit's statement, which succinctly describes the intention behind our profession's conservative approach to health care," said ACA President Keith Overland, DC.

The HOD met in conjunction with the 2014 National Chiropractic Legislative Conference (NCLC) and Education Symposium. Be sure to visit ACA's Facebook fan page for photos, updates and videos from the conference. Twitter users can talk about the event using the hashtag #NCLC2014.

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

 

Hundreds of Chiropractic Supporters Advocate for Patients, Expanded Access at NCLC 2014

Washington, D.C.—Hundreds of chiropractic physicians, students and supporters joined the American Chiropractic Association (ACA) in Washington, D.C. today to visit with lawmakers on Capitol Hill as part of the 2014 National Chiropractic Legislative Conference (NCLC) and Education Symposium.

Doctors from all walks of the profession came to Washington to tell their stories and advocate on behalf of the patients they serve. Attendees urged lawmakers to support bills that would benefit patients, expand access to chiropractic services for veterans and active-duty military personnel, and help chiropractic graduates qualify for federal programs that would enable them to practice in underserved areas in exchange for student loan debt relief.

Keynote speaker, Sen. Jerry Moran (R-Kan.)—a member of the Senate Appropriations Committee, the Banking, Housing and Urban Affairs Committee, and the Veterans’ Affairs Committee—discussed how his commitment to improving the health and quality of life of our nation’s veterans ties into his support for chiropractic.

“When we advocate for chiropractic, we are really advocating for patients, including veterans,” said Sen. Moran. “We must honor our commitment to provide for the military, including providing for their health care. Chiropractic is a way to provide for veterans and their communities.”

NCLC Plenary Speaker, Fabrizio Mancini, DC, an internationally acclaimed educator, philanthropist and president emeritus of Parker University, shared his experiences promoting whole-person wellness, and how that focus will be essential in the formed health care landscape.

“Just because our health care system has a hard time fitting us in its box doesn’t mean we can’t serve that system,” said Dr. Mancini. “Chiropractic has what the new health care system is looking for. We get more results than most, we just have to share them with the public.”

Attendees also heard from the prime sponsor of the Chiropractic Care Available to All Veterans Act, Sen. Richard Blumenthal (D-Conn.), who was part of a bipartisan coalition of senators responsible for including major portions of the bill in larger legislation that was recently sent to the full Senate for consideration; Rep. Bill Enyart (D-Ill.), a cosponsor of the Chiropractic Health Parity for Military Beneficiaries Act designed to further integrate the services provided by doctors of chiropractic in the U.S. Department of Defense (DoD) health delivery system; and Rep. Cory Gardner (R-Colo.), a member of the influential House Energy and Commerce Committee.

ACA President Keith Overland, DC, in his opening address to attendees, focused on the importance of creating a level playing field for chiropractic physicians in order to improve the health and wellness of the American people and U.S. veterans. “Doctors of chiropractic offer safe approaches for helping veterans in pain, so your message to lawmakers is so important,” he said.

To complete the day, ACA will host a “Green-tie Gala” event to honor retiring Sen. Tom Harkin (D-Iowa), a long-time chiropractic champion on the Hill who is known for his penchant for wearing green ties.

Visit ACA’s website for video excerpts of the conference, and be sure to visit ACA’s Facebook fan page for photos, updates and videos from the conference. Twitter users can talk about the event using the hashtag #NCLC2014.

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

 

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ACA Legislative Alert Bulletin 2: Further Integrate the Services Provided by Doctors of Chiropractic in the Veterans Affairs Health System

In order to maximize the profession’s advocacy activities at the National Chiropractic Legislative Conference (NCLC 2014), the ACA is coordinating an advance online grassroots campaign in an effort to “soften the beachhead,” when the ground forces arrive in Washington for Capitol Hill visits on February 27th. Please read carefully and take the specific action requested below.

BACKGROUND: The Department of Veterans Affairs (DVA) health care system continues to discriminate against doctors of chiropractic and America’s veterans who need and deserve the essential services DCs provide. We have long argued that the DVA needs to “fully integrate” doctors of chiropractic into their healthcare system, however, chiropractic services continue to remain unavailable in nearly half of the nation’s major DVA treatment facilities. This lack of care is not only unfair to America’s veterans, but sends a very damaging signal to the consumer public, private employers, and other hospitals and healthcare systems, that the DVA does not consider the services provided by doctors of chiropractic to be important or valued enough to be made routinely available to all consumers and patients in need of our care. Gaining “full inclusion” in the DVA would send a strong signal not only to our veterans, but to all insurers, employers, medical doctors and hospitals on a nationwide basis.

There is legislation currently pending in the U.S. House of Representatives that would greatly expand our profession’s presence within the DVA health care system, HR 921, the Chiropractic Care Available to All Veterans Act. We urgently need to gain additional cosponsors and support for this bill. We simply need to generate a strong grassroots response on HR 921, in order to increase the likelihood that the legislation will be enacted into law this year.

ACTION NEEDED: Please CLICK HERE to go to the ACA’s Legislative Action Center. From this link, you will be able to send the appropriate pro-chiropractic message to your elected federal official on Capitol Hill on the issue described above.

Remember -- all of the information you need to effectively respond to this Alert Bulletin can be conveniently accessed with just a few mouse clicks -- so please respond this important request ASAP. Also please note: You can greatly increase the effectiveness of this grassroots campaign by forwarding this message to your staff members, family and patients, anyone can access the ACA Legislative Action Center and we encourage them to do so.

 

ACA Legislative Alert Bulletin 1: Important Medicare Payment Issue

In order to maximize the profession’s advocacy activities at the National Chiropractic Legislative Conference (NCLC 2014), the ACA is coordinating an advance online grassroots campaign in an effort to “soften the beachhead,” when the ground forces arrive in Washington for Capitol Hill visits on February 27th.

This is the first in a series of three Legislative Alert Bulletins that requires your immediate grassroots response. Please read carefully and take the specific action requested below.

BACKGROUND: In the near future all Part B Medicare providers, including doctors of chiropractic, will face draconian reductions (over 27%) in their Medicare payment rates unless Congress takes legislative action to “fix” a flaw in the Sustainable Growth Rate (SGR) payment formula that exists under current law.

Specifically, Congress needs to enact new legislation to prevent the imposition of these prior to March 31 of this year. As a “solution” to this problem, the American Chiropractic Association favors the enactment of legislation, which would provide a long-term “fix” to the SGR problem. While the legislation currently under consideration does not address all problems and limitations that DCs have with the Medicare program, it does include a new Merit-Based Incentive Payment System (MIPS) and DCs are specifically made eligible to qualify for this component.

ACTION NEEDED: Please CLICK HERE to go to the ACA’s Legislative Action Center. From this link, you will be able to send the appropriate pro-chiropractic message to your elected federal official on Capitol Hill on the issue described above.

Remember -- all of the information you need to effectively respond to this Alert Bulletin can be conveniently accessed with just a few mouse clicks -- so please respond to this important request ASAP. Also please note: You can greatly increase the effectiveness of this grassroots campaign by forwarding this message to your staff members, family and patients, anyone can access the ACA Legislative Action Center and we encourage them to do so.