Like no other period in its history, the chiropractic profession is enjoying elements of legitimacy and social acceptance. Witness the the Cherkin study (1989) that cited higher patient satisfaction with chiropractic management of low back pain compared to family physicians; the results of the clinical trial of Meads et al. (1990) in Great Britain; and witness the critical study of chiropractic manipulation in the nation's largest back pain assessment project sponsored by the Agency on Health Care Policy and Research at the University of Washington. But these are all examples of assessment from outside the chiropractic profession. Just as important to our profession is self-evaluation and self-assessment ... from the inside.
Chiropractors will have the rare opportunity to witness such an exercise in self-assessment at the annual convention of the California Chiropractic Association (CCA) next month in Monterey. One of the educational tracts at this convention will be the Consortium for Chiropractic Research's (CCR) annual CORE (Conference on Research and Education) program, "Emphasis on Consensus." This will be an exercise in procedure and technology assessment employing fundamental elements of self-assessment, including literature review, deliberation by expert panels, and use of consensus methods to reach conclusions.
The basic challenge to any health care procedure is to contribute positively to the health and well-being of the patient. This challenge will be the foundation of concepts such as outcome measures, outcomes management, and quality assurance. It is what drives federal and state scrutiny (e.g. Medicare and workers' compensation) to characterize effectiveness of health care modalities, their possible adverse reactions, and explanation of geographic, institutional or practitioner variations in health care delivery. Today there is no health care discipline that is spared from facing this challenge.
Assessment of procedures and technology can be accomplished through a variety of methods, ranging from difficult and expensive randomized controlled clinical trials to case series assessment and individual case studies. At the Monterey meeting and subsequent conferences, the process to investigate chiropractic procedures will employ literature reviews, expert panels, consensus development, and opinion surveys.
Eight topics (modules) were selected for the 1991 conference on research and education: leg length insufficiency; static cervical x-ray analysis; lumbar motion palpation; skin temperature assessment; short lever specific contact procedures; short lever manual force mechanically assisted procedure; short and long lever manual force mechanically assisted procedures; and short lever mechanical force manually assisted procedure.
A critical review of the literature of each topic will be performed by such eminent DCs as Donna Mannello, Edward Owens, David Panzer, Gregory Plaugher, Thomas Bergmann, and Paul Osterbauer. This should bring the attendees up to date on clinically useful concepts and provide a frame of reference on the topic.
Expert panels have been assembled consisting of the leading experts in the profession for the various topics. The panelists will discuss the utility of the procedure in their technique paradigm. Each panel will have a trained facilitator that will use consensus methods to extract agreement (or disagreement) on conclusions of these procedures or technologies. The facilitators will be DCs Alan Adams, Charles Sawyer, William Meeker, and Reed Phillips.
It is during this deliberation that input from the audience will be allowed. Each topic will end with the recording of consensus statements and minority reports. As a result, statements on the current status of the procedure or technology and agendas for future study will emerge.
Parallel to this effort is an "opinion survey" project by the CCR, funded through a grant by the Foundation for Chiropractic Education and Research (FCER). This survey will primarily explore attitudes and opinions relative to standards of care, but it will also investigate the procedures and technology commonly used in chiropractic practice. Based on the outcomes of this opinion survey and the Monterey conference, the CCR/Technic Council steering committee will determine the agenda for further assessment conferences. Subsequent conferences will likely investigate some of the more controversial technologies and other common modes of diagnosis and treatment.
Throughout the history of the chiropractic profession advancing technology has found its way into routine practice without yielding to formal scrutiny of reliability or validity. The time has come for this trend to change. Following the mandates of the first Consensus Conference on Validation of Chiropractic Methods held in Seattle last year, the assessment sequence for formal appraisal of chiropractic procedures and technology can be accomplished. This program in Monterey is your opportunity to be a part of this validation exercise and witness chiropractic history. Plan to attend this year's CORE Conference and join over 40 of our professions' top leaders in this effort toward consensus.
Daniel T. Hansen, D.C., D.A.B.C.O., F.I.C.C.
CCR liaison
Olympia, WA
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