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7

Duration of Care for Correction of Vertebral Subluxation

RECOMMENDATION – Unchanged

Additional Commentary

Chiropractors are encouraged to employ a clinically driven variable length of care format in which the duration of care is determined by each individual patient’s progress toward meeting measurable objectives, set in individualized care plans and identified during individual assessment. This application ensures that patients are not over- or underutilizing a health-care resource and are currently receiving the best possible care.

When developing a care plan based on reduction, correction and stabilization of the subluxation the attending chiropractor should take into consideration many associated and aggravating factors. These will include details about the extent and character of the patient's subluxations. For example: How long have they been subluxated? How is this subluxation affecting biomechanics, their nervous system, muscles, ligaments and involved joints? The relationship between X-ray findings, chiropractic and physical exam findings and instrumentation readings may need to be correlated.

It is important to consider the patient's age in respect to their subluxations and how the age will impact the outcome. Since physical trauma is one of the potential causes of subluxation it is important to consider whether or not the patient had previous injuries, traumas or accidents. This should not be limited to single instances of trauma but also consider repetitive injuries, microtrauma on a daily basis etc. These should all be considered in terms of how they will interfere with subluxation correction and affect long term outcome.

Other co-existing health conditions may also affect the patient’s response to care since if a patient is dealing with chronic health problems of any sort this may impede progress. The patient’s work and home life demands may also have a bearing on how much of a correction they attain and should be considered in determining a care plan and prognosis. The patient's sleeping habits may interfere with long-term correction and stabilization of the subluxation and should be considered.

A patient’s ability to exercise or their lack of compliance to a prescribed exercise regimen may impede their progress and diminish their response. And in some cases, the patient’s weight may have a bearing on their recovery. Other factors include smoking, alcohol, nutritional problems and socio-emotional aspects of their life.

Justification for high frequency initial and extended wellness care plans should be based on a combination of basic science, technique, objective assessment of physiological function, structural changes and quality of life issues. The practitioner should ideally choose from several of these to develop their care plan and to justify its implementation.

No matter which of the various models of vertebral subluxation one chooses to address in clinical practice there are two components that are common to all models. These components are _________________________________________________________ 134 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision

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