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AHCPR

AHCPR. AGENCY FOR HEALTH CARE POLICY AND RESEARCH. 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. AHCPR.

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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

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