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natalie-jacobson

AHCPR - PowerPoint PPT Presentation

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AHCPR
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  1. AHCPR AGENCY FOR HEALTH CARE POLICY AND RESEARCH

  2. AHCPR • 1994 US GOVERNMENT STUDY ON ACUTE LOW BACK PAIN IN ADULTS • SPINAL MANIPULATION IS THE MOST EFFECTIVE FORM OF CARE IN THE FIRST MONTH OF ACUTE LOW BACK PAIN

  3. AHCPR • SINCE 94% OF MANIPULATION IS PERFORMED BY CHIROPRACTORS PATIENTS SHOULD BE REFERRED FOR ALL ACUTE LOW BACK PAIN

  4. AHCPR • THREE MAJOR GUIDELINES IN THE STUDY

  5. AHCPR • 1) IF MANIPULATION HAS NOT RESULTED IN SYMPTOMATIC IMPROVEMENT IN 1 MONTH OF TREATMENT, IT SHOULD BE STOPPED AND REEVALUATED. THIS PUTS A DUTY “STANDARD OF CARE” ON THE PHYSICIAN TO PERFORM AN OBJECTIVE EVALUATION

  6. AHCPR • TO DETERMINE FURTHER CARE. SUBJECTIVE IMPROVEMENT IS NOT SUFFICIENT TO JUSTIFY CONTINUATION OF CARE

  7. AHCPR • TWO METHODS OF ASSESSMENT • 1) VAS - DOCUMENT IN PATIENT’S OWN HANDWRITING • 2) OBJECTIVE INDICATORS - ADLS AND OSWESTRY

  8. AHCPR • 2) EVIDENCE SUGGESTS THAT PLAIN FILM X-RAYS ARE RARELY USEFUL IN EVALUATING OR GUIDING THE TREATMENT OF ACUTE LOW BACK PAIN IN THE ABSENCE OF “RED FLAGS”. X-RAYS SHOULD ONLY BE TAKEN AFTER INITIAL ASSESSMENT AND TREATMENT

  9. AHCPR • ROUTINE LOW BACK PAIN DOES NOT WARRANT X-RAYS • NO “RED FLAGS” - NO X-RAYS

  10. AHCPR • WHAT IS A “RED FLAG”? • 1) ARTHRITIS • 2) DISC HERNIATION • 3) PREVIOUS TRAUMA • 4) FRACTURE • 5) TUMOR

  11. AHCPR • SUBLUXATION IS NOT A REASON TO X-RAY

  12. AHCPR • WHEN TO X-RAY IN ACUTE LOW BACK PAIN • 1) TRAUMA - SIGNIFICANT TRAUMA OF ANY AGE PERSON • 2) MILD TRAUMA IN AGE >50 • 3) HISTORY OF PROLONGED STEROID USE

  13. AHCPR • 4) ANYONE OVER AGE 70 • 5) PRIOR CANCER OR SERIOUS INFECTION • 6) DRUG ABUSE • 7) LOW BACK PAIN WORSE WITH REST • 8) UNEXPLAINED WEIGHT LOSS

  14. AHCPR • 3) PATIENT WITH ACUTE LOW BACK PAIN ALONE WITH NEITHER SUSPICIOUS FINDINGS OR SIGNIFICANT NERVE ROOT COMPRESSION NOR ANY (+) RED FLAGS, DO NOT NEED SURGICAL CONSULTATION FOR A LUMBAR DISC

  15. AHCPR • ALWAYS LOOK FOR RED FLAGS IN THE EXAM AND HISTORY ON EVERY PATIENT • THIS PUTS THE DUTY ONTO THE PMD TO REFER NOT TO AN ORTHOPEDIST BUT TO A CHIROPRACTOR

  16. AHCPR • THE USE OF PT AND MODALITIES ARE NOT RECOMMENDED FOR ACUTE LOW BACK PAIN. THIS WOULD INCLUDE ICE, HEAT, DIATHERMY, MASSAGE, ULTRASOUND, T.E.N.S., AND ACUPUNCTURE

  17. AHCPR • YOU SHOULD HAVE WRITTEN IN YOUR CONSENT FORM THAT THESE MODALITIES MAY OR MAY NOT BE BENEFICIAL AND THAT THEY UNDERSTAND THAT YOU STILL WANT TO USE THEM. • ALSO INFORM THEM THAT THEIR INSURANCE MAY NOT PAY