Abstract
Objective
The purposes of this project were to develop consensus definitions for a set of best
practices that doctors of chiropractic may use for promoting health and wellness and
preventing disease and to describe the appropriate components and procedures for these
practices.
Methods
A multidisciplinary steering committee of 10 health care professionals developed seed
statements based on their clinical experience and relevant literature. A Delphi consensus
process was conducted from January to July 2011, following the RAND methodology. Consensus
was reached when at least 80% of the panelists were in agreement. There were 44 Delphi
panelists (36 doctors of chiropractic, 6 doctors of philosophy, 1 doctor of naturopathy,
1 registered nurse).
Results
The statements developed defined the terms and practices for chiropractic care to
promote health and wellness and prevent disease.
Conclusion
This document describes the procedures and features of wellness care that represent
a reasonable approach to wellness care and disease prevention in chiropractic clinical
practice. This living document provides a general framework for an evidence-based
approach to chiropractic wellness care.
Key Indexing Terms
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References
- Practice Analysis of Chiropractic. NBCE, Greeley, CO2010
- Haldeman S Chapman-Smith D Petersen DJ Guidelines for chiropractic quality assurance and practice parameters. Aspen Publishers, Gaithersburg, MD1993
- A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I.J Manipulative Physiol Ther. 2000; 23: 1-9
- Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II.J Manipulative Physiol Ther. 2000; 23: 10-19
- Content of practice.in: Cherkin D Mootz R Chiropractic in the United States: training, practice and research: AHCPR Publication No. 98-N002. 1997: 67-90
- Preventative chiropractic: what justification?.Chiropr J Aust. 1991; 21: 10-12
- Maintenance care in chiropractic—what do we know?.Chiropr Osteopat. 2008; 16: 3
- Medicare Benefit Policy Manual. 2011
- Consensus terminology for stages of care: acute, chronic, recurrent, and wellness.J Manipulative Physiol Ther. 2010; 33: 458-463
- Definitions of care: Chiropractic reaches consensus on terminology for stages of care.ACA Today News. November 2010;
- Job analysis of chiropractic. NBCE, Greeley, CO2005
- A survey of 492 U.S. chiropractors on primary care and prevention-related issues.J Manipulative Physiol Ther. 1995; 18: 57-64
- A survey of US chiropractors on clinical preventive services.J Manipulative Physiol Ther. 2004; 27: 287-298
- ACA Wellness Model. American Chiropractic Association, Arlington, VA2001
- Guide to Clinical Preventive Services 2010–2011: Recommendations of the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (AHRQ), Washington, DC2010 (Available from)
- Health maintenance care in work-related low back pain and its association with disability recurrence.J Occup Environ Med. 2011; 53: 396-404
- Does maintained spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?.Spine (Phila Pa 1976). 2011; 7: 1427-1437
- Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain and dizziness in older adults.J Manipulative Physiol Ther. 2009; 32: 438-447
- Chiropractic care for older adults: effects on balance, dizziness and chronic pain.J Manipulative Physiol Ther. 2009; 32: 431-437
- The use of measures of general health status in chiropractic patients: a pilot study.Palmer J Res. 1995; 2: 39-45
- The Nordic back pain subpopulation program: a 1-year prospective multicenter study of outcomes of persistent low-back pain in chiropractic patients.J Manipulative Physiol Ther. 2005; 28: 90-96
- A longitudinal assessment of chiropractic care using a survey of self-rated health wellness & quality of life: a preliminary study.J Vertebr Subluxat Res. 1999; 3: 1-9
- Changes in general health status during upper cervical chiropractic care: PBR progress report.CRJ. 1998; 5: 9-16
- Wellness lifestyles II: Modeling the dynamic of wellness, health lifestyle practices, and Network Spinal Analysis.J Altern Complement Med. 2004; 10: 357-367
- The role of the cervical spine in balance and risk of falling in the elderly.Chiropr J Aust. 2004; 34: 19-22
- Chiropractic maintenance care and quality of life of a patient presenting with chronic low back pain.J Manipulative Physiol Ther. 2005; 28: 136-142
- Quality of life improvements and spontaneous lifestyle changes in a patient undergoing subluxation-centered chiropractic care: a case study.J Vertebr Subluxat Res. 2006; 1: 1-15
- Chiropractic effects on athletic ability.J Chiropr Res Clin Invest. 1991; 6: 84-87
- General health status as measured by the SF-36 of patients with spinal disorders: a chiropractic perspective.Chiropr J Aust. 2007; 37: 100-105
- Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study.J Manipulative Physiol Ther. 2004; 27: 509-514
- Chiropractic care and changes in physical state and self-perceptions in domains of health among public safety personnel: a longitudinal follow-up study.J Vertebr Subluxat Res. 2009; 1: 1-11
- The effect of chiropractic adjustments on movement time: a pilot study using Fitts Law.J Manipulative Physiol Ther. 2006; 29: 257-266
- Changes in physical state and self-perceptions in domains of health related quality of life among public safety personnel undergoing chiropractic care.J Vertebr Subluxat Res. 2007; 1: 1-7
- The presenting complaints of pediatric patients for chiropractic care: results from a practice-based research network.Clin Chiropr. 2008; 11: 193-196
- Multinational survey of chiropractic patients: reasons for seeking care.J Can Chiropr Assoc. 2008; 52: 175-184
- Maintenance care: towards a global description.J Canadian Chiropr Assoc. 2001; 45: 100-105
- The Nordic Maintenance Care Program—time intervals between treatments of patients with low back pain: how close and who decides?.Chiropr Osteopat. 2010; 18: 5
- Health promotion attitudes of chiropractic physicians.Am J Chiropr Med. 1990; 3: 71-76
- Chiropractic in Britain.Ann Swiss Chiropractors' Assoc. 1976; 6: 207-218
- Preliminary report: practice-based measures of wellbeing in a typical Australian chiropractic practice.Chiropr J Aust. 2007; 37: 126-134
- A preliminary investigation of the relationship between certain practice characteristics and practice location: chiropractor-population ratio.J Manipulative Physiol Ther. 1989; 12: 253-258
- Persistent back pain—why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists.Eur J Pain. 2006; 10: 67-76
- Recently graduated chiropractors in Australia. Part 2: certain professional attitudes and practice characteristics.J Aust Chiropractors' Assoc. 1987; 17: 151-154
- Preventative chiropractic and the chiropractic management of visceral conditions: is the cost to chiropractic acceptance justified by the benefit to health care?.Chiropr J Aust. 1991; 21: 95-101
- Treating Tobacco Use and Dependence: 2008 Update.U.S. Department of Health and Human Services, Public Health Service, Rockville (Md)2008
- How does physician advice influence patient behavior? Evidence for a priming effect.Arch Fam Med. 2000; 9: 426-433
- Tobacco cessation via doctors of chiropractic: results of a feasibility study.Nicotine Tob Res. 2010; 12: 305-308
- “Chiropractors Against Tobacco” pilot project: a practice-based research study.J Am Chiropr Assoc. 2005; 42: 8-15
- Health information and promotion in chiropractic clinics.J Manipulative Physiol Ther. 2002; 25: 240-245
- The health information brochure: a useful tool for chiropractic practice?.J Manipulative Physiol Ther. 2001; 24: 331-334
- Prescribing wellness: a case study exploring the use of health information brochures.J Manipulative Physiol Ther. 2004; 27: 262-266
- Nutrition and youth soccer for childhood overweight: a pilot novel chiropractic health education intervention.J Manipulative Physiol Ther. 2008; 31: 434-441
- The health care provider's role and patient compliance to health promotion advice from the user's perspective: analysis of the 2006 National Health Interview Survey data.J Manipulative Physiol Ther. 2010; 33: 413-418
- Chiropractic and medical use of health promotion in the management of arthritis: analysis of the 2006 National Health Interview Survey.J Manipulative Physiol Ther. 2010; 33: 419-424
- Characterization of health status and modifiable risk behavior among United States adults using chiropractic care as compared with general medical care.J Manipulative Physiol Ther. 2009; 32: 414-422
- Provision of nutrition counseling, referrals to registered dietitians, and sources of nutrition information among practicing chiropractors in the United States.J Am Diet Assoc. 2000; 100: 928-933
- Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status.Council on Chiropractic Education, Scottsdale, AZ2007 (Available from)
- The Council on Chiropractic Education's new wellness standard: a call to action for the chiropractic profession.Chiropr Osteopat. 2006; 14: 23
- Best practices recommendations for chiropractic care for children: results of a consensus process.J Manipulative Physiol Ther. 2009; 32: 639-647
- Best practices recommendations for chiropractic care for older adults: results of a consensus process.J Manipulative Physiol Ther. 2010; 33: 464-473
- Maintenance care.Top Clin Chiropr. 1996; 3: 32-35
- Chiropractic maintenance treatment, a useful preventative approach?.Prev Med. 2009; 49: 99-100
- Prevention and health promotion by chiropractors.Am J Lifestyle Med. 2008; 2: 537-545
- The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network.Explore (NY). 2009; 5: 290-295
- The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?.Chiropr Osteopat. 2009; 17: 1
- The Nordic maintenance care program: case management of chiropractic patients with low back pain—defining the patients suitable for various management strategies.Chiropr Osteopat. 2009; 17: 7
- The Nordic Maintenance Care Program—an interview study on the use of maintenance care in a selected group of Danish chiropractors.Chiropr Osteopat. 2009; 17: 5
- The Delphi technique: myths and realities.J Adv Nurs. 2003; 41: 376-382
- The RAND UCLA appropriateness method user's manual. RAND Corp, Santa Monica (Calif)2003
- Are we asking the right questions?.Chiropr J Aust. 2007; 37: 15-18
- Health promotion and disease prevention in clinical practice.2nd ed. Williams & Wilkins, Baltimore2008
- Chiropractic and public health: current state and future vision.J Manipulative Physiol Ther. 2008; 31: 397-410
- Public health, wellness, prevention, and health promotion: considering the role of chiropractic and determinants of health.J Manipulative Physiol Ther. 2009; 32: 405-412
- Evidence-based medicine: how to practice and teach EBM.2nd ed. Church Livingston, Edinburgh2000
- Are evidence-based practice and best practice the same?.West J Nurs Res. 2002; 24: 591-597
- Evidence-based interventional pain management: principles, problems, potential and applications.Pain Physician. 2007; 10: 329-356
- Management of chronic spine-related conditions: consensus recommendations of a multidisciplinary panel.J Manipulative Physiol Ther. 2010; 33: 484-492
- A public health immunization resource web site for chiropractors: discussion of current issues and future challenges for evidence-based initiatives for the chiropractic profession.J Manipulative Physiol Ther. 2009; 32: 500-504
- A survey of wellness management strategies used by Canadian doctors of chiropractic.J Manipulative Physiol Ther. 2011; 34: 388-393
- Fall risk profile and quality-of-life status of older chiropractic patients.J Manipulative Physiol Ther. 2011; 34: 78-87
- The ABC's of health promotion and disease prevention in chiropractic practice.J Chiropr Med. 2003; 2: 107-110
- Process versus outcome: challenges of the chiropractic wellness paradigm.J Chiropr Humanit. 2009; 16: 50-53
- Chiropractic and wellness care.J Chiropr Humanit. 1994; 4: 3-19
- Familiarity with and advocacy of Healthy People 2010 goals by Mississippi Chiropractic Association members.J Manipulative Physiol Ther. 2011; 34: 394-406
- Evidence-based guidelines for the chiropractic treatment of adults with headache.J Manipulative Physiol Ther. 2011; 34: 274-289
- Improving preventive health services training in chiropractic colleges part II: enhancing outcomes through improved training and accountability processes.J Manipulative Physiol Ther. 2009; 32: 453-462
- Personal and professional immunization behavior among Alberta chiropractors: a secondary analysis of cross-sectional survey data.J Manipulative Physiol Ther. 2009; 32: 448-452
- Are patients receiving health promotion advice in the chiropractic teaching clinic setting?: an impact assessment of a brief intervention to increase advising rates and goal setting.J Chiropr Educ. 2011; 25: 132-141
- Health promotion practices in two chiropractic teaching clinics: does a review of patient files reflect advice on health promotion?.J Chiropr Educ. 2010; 24: 159-164
- Intentions of chiropractic interns regarding use of health promotion in practice: applying theory of reasoned action to identify attitudes, beliefs, and influencing factors.J Chiropr Educ. 2009; 23: 17-27
- Factors associated with changes in knowledge and attitude towards public health concepts among chiropractic college students enrolled in a community health class.J Chiropr Educ. 2008; 22: 127-137
- Curriculum reform in a public health course at a chiropractic college: are we making progress toward improving clinical relevance?.J Chiropr Educ. 2007; 21: 20-27
- How much health promotion and disease prevention is enough? Should chiropractic colleges focus on efficacy training in screening for family violence?.J Chiropr Educ. 2006; 20: 128-137
- Knowledge, perceptions, and practices of chiropractic interns in the early detection of atypical moles.J Chiropr Med. 2011; 10: 77-85
- Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, preexperimental, feasibility study.J Chiropr Med. 2009; 8: 156-164
- Public health advocacy and chiropractic: a guide to helping your community reach its health objectives.J Chiropr Med. 2008; 7: 71-77
- The interrelationships of wellness, public health, and chiropractic.J Chiropr Med. 2005; 4: 191-194
- Clinical practice guidelines we can trust.The National Academies Press, Washington, DC2011
Article info
Publication history
Published online: June 28, 2012
Accepted:
January 12,
2012
Received in revised form:
December 7,
2011
Received:
September 16,
2011
Identification
Copyright
© 2012 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.