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A Tale of Two Dentists

Reflections on Choosing Wisely During a Trip to the Dentist

Meeting over coffee recently, Drs. Christine Goertz and Michele Maiers discovered that each had recently been to the dentist. After comparing notes, they agreed that their dentists were both professional, friendly, conducted a thorough patient history, and performed an appropriate examination. Then both dentists wanted to take intraoral X-rays as part of the examination process. Armed with the evidence and knowledge about current American Dental Association (ADA) guidelines, the chiropractors declined the X-rays, based primarily upon concerns about unnecessary exposure to radiation and cost. From that point on, their experiences became very different.

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Q&A with NCLC 2019 Presenters: Dr. Robert Vining

ACA’s annual meeting, the National Chiropractic Leadership Conference, brings you cutting-edge, evidence-based education sessions featuring some of the chiropractic profession’s most respected thought leaders and content experts. Many sessions also offer continuing education credits. Here we pose questions to one of the presenters: Robert Vining, DC, senior research clinician with the Palmer Center for Chiropractic Research. His presentation is, “Rational Clinical Decisions: The Diagnostic Aspect of Evidence-based Clinical Practice.”

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Choosing Outcome Assessments for Back Pain

Patient-reported outcome measures quantify patients’ subjective symptoms and are often more in line with accomplishing patient-centered goals. Patient-reported outcomes can give valuable information to evaluate the success of a treatment plan and aid in determining a prognosis based on past response. They are also used by insurance companies for re-imbursement purposes, such as determining medical necessity. Chiarotto et al. developed a core outcome set for use in clinical practice with accompanying suggested measures for patients with low back pain.

Author: Zac Shannon
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If Not Bone Out of Place, Then What?

Learn ACA Survey Course Shows How Chiropractic Theory Has Changed and Where the Science Is Taking Us

For more than a century, chiropractic science—at least as offered by many chiropractors—was frozen in late 19th century medical thought. Because the founders spoke of “tone” and the “safety-pin cycle,” it became almost a rallying cry for many of the followers. But has chiropractic science advanced since that time, and if so, will chiropractors embrace it? Many of you have read my theory textbooks through the years, but have you kept up with our modern science? There is a new story to tell. The new story is based on solid science that dovetails nicely with science from related healthcare disciplines, and that places [the chiropractic profession] squarely in the middle of interdisciplinary recommendations for conservative spine care and positions us as a substitute for old-school use of opioids and back surgery--instead of putting us out on a ledge, preaching against interdisciplinary care.

Author: Robert Leach
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Chiropractic Education and Radiography Best Practices

ACA’s Choosing Wisely recommendations are consistent with X-ray guidance in today’s classroom and trusted texts.

In the past year, many chiropractors have discussed indications for radiographic examination with renewed interest. In particular, they have questioned the X-ray recommendations of the Choosing Wisely initiative, a project of the American Board of Internal Medicine that seeks to promote more effective use of healthcare resources. The recommendations are hardly revolutionary, and well in line with current radiology education. In my own final radiology classes, professors emphasized that what we learned was only the foundation of what we would need in practice, and a mere fraction of what our peers would learn should they choose to become chiropractic radiologists. The recommendations in Choosing Wisely are shorthand for what we already know. 

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Essential Skills for Managing Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness and vertigo. The condition is characterized by brief episodes of dizziness, nausea, and/or nystagmus triggered by head movement. Over 7 percent of the population will experience BPPV at some point in their lifetime and 80 percent of those patients will require medical treatment. Chiropractors are uniquely suited to differentiate BPPV from the similar-looking cervicogenic vertigo. Both conditions are very amenable to treatment; however, each is managed quite differently. Successful outcomes are predicated upon a solid understanding of both.

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Research Review: Exercise Interventions for Cognitive Function in Adults Older Than 50

As any population ages, cognitive decline becomes more of an issue. Maintaining a physically active lifestyle has been shown to help reduce age-related cognitive declines and incidence of dementia. This research review focuses on a systemic review with meta-analysis summarizing the evidence specific to cognitive benefits of exercise for people over 50. Prior research has shown conflicting results, due in part to the use of restrictive inclusion criteria. However, the results of this review show promise for both aerobic and resistance training.

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Choosing Wisely: Separating Facts from Fears

It has been just over a year since many in the chiropractic profession first learned that the American Chiropractic Association (ACA) joined more than 80 medical specialty society partners to participate in an initiative that is sponsored by the American Board of Internal Medicine Foundation. This initiative’s mission is to “promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” It is called the Choosing Wisely campaign1 and it has generated more spirited discussion among doctors of chiropractic than I can recall since release of the Mercy Conference Proceedings in 1993.

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Engaging the Community Through Diversity in Research

An Introduction to Diverse Needs

While a chiropractic student, I traveled with a group of medical providers to a community in Ghana to provide supplies, assist with health screens in remote villages, and work in a local hospital within a variety of departments. During my time there, I interviewed different community members employed by the hospital or by non-governmental organizations working with the hospital about their perceived health burdens and openness to chiropractic. Unexpectedly, interviewees expressed that while they practiced a Western medicine model, there was some uncertainty on how much that body of knowledge applied to them since they felt so underrepresented in the studies that contributed to that knowledge. The patients and study participants described were rarely people that came from similar geography, cultures, and lifestyles or had physical characteristics they identified with. 

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Research Review: Chiropractic Care and Risk for Acute Lumbar Disc Herniation: a Population-based Self-controlled Case Series Study

The objective of this study was to compare the associations between primary care physician and chiropractic care in relation to acute lumbar disc herniation (LDH) with early surgery. The clinical picture of LDH in the early stages (i.e. the prodromal phase), in which low back pain progresses to radicular leg pain and possible neurologic signs, is often uncertain and can be a confusing time for both patients and clinicians. Thus, making a diagnosis of LDH during the early course of symptoms is often very difficult. The study's hypothesis was that chiropractic care could only be thought to increase the risk for acute LDH if the measured association between chiropractic visits and acute LDH exceeded the association between PCP visits and acute LDH.

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