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Another key aspect articulated in the ACC document concerns case management issues. It outlines, in a generic way, how chiropractors conduct themselves on a clinical level:

"Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to

other

health

care

providers."

The CCP Guidelines address a distinct manner in which chiropractic clinicians utilize the information, feedback and empirical results each case accumulates. For this reason, the Guidelines are not linked to various diseases or conditions the patient may or may not have, before or after care has initiated. The World Health Organization defines health as being "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." Given this broad definition of health, epistemological constructs borrowed from the social sciences may demonstrate health benefits not disclosed by randomized clinical trials. Health benefits such as improvement in self-reported quality-of-life, decreased health care costs, behaviors associated with decreased morbidity, and patient satisfaction may be evaluated using such methods. 16

This performance-based domain focuses the doctor-patient relationship on the standards set by personal baselines and establishes guidelines for the utility of various chiropractic techniques. This type of chiropractic care is in a context with other non-invasive disciplines and is stratified into discrete application-based domains across a spectrum of parameters related to well-being.

Techniques and methods for correcting subluxation must be judged on their intended outcome and most if not all chiropractic techniques have some physiological and/or structural outcome that measures their results. Further, some techniques have as their goals - improvement in quality of life, an improved sense of well-being and a better sense of relationship with the patient’s environment and society.

Several studies discussed previously warrant further discussion in this context. Blanks, Schuster and Dobson17 published the results of a retrospective assessment of subluxation-based chiropractic care on self-related health, wellness and quality of life. This is the largest study of its kind ever undertaken regarding a chiropractic population. After surveying 2,818 respondents in 156 clinics, a strong connection was found between persons receiving chiropractic care and self-reported improvement in health, wellness and quality-of-life. 95% of respondents reported that their expectations had been met, and 99% wished to continue care.

136

_________________________________________________________ Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision

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