In what is sure to create a storm of controversy the American Chiropractic Association (ACA) released a list of five tests it states are commonly ordered but not always necessary in chiropractic care. The recommendation includes the admonition to not take spinal x-rays in acute low back pain patients unless there are so called Red Flags and to never take repeat x-rays to monitor progress. Teaming up with ABIM Foundation and Consumer Reports, the ACA’s President David Herd DC referred to these as “unneeded or overused services” and that following these recommendations would yield the “best possible care”.
CLICK HERE for the press release
The recommendations by the ACA, which has been pushing hard to remove subluxation language from Medicare and to expand the scope of practice of chiropractic nationwide including drugs, are at odds with what is considered to be a standard of care within chiropractic.
A number of chiropractic techniques rely on x-rays in order to determine the misalignment (biomechanical) component of the vertebral subluxation and imaging (especially plain film) is the only objective, valid and reliable method to make that determination.
Further, those techniques require the taking of follow-up x-rays in order to determine whether or not the misalignment has been reduced or corrected.
Insurance companies have for decades attempted to deny reimbursement for radiographs taken for this purpose. Subluxation deniers, and some trade organizations like the medically oriented ACA, have sought to paint such practices as unprofessional and to steer consumers away from chiropractors who rely on these procedures in order to administer care.
The ACA’s recommendations regarding x-rays are at odds with several other recommendations by chiropractic trade organizations, best practices, and standard of care guidelines as well as what is taught at several chiropractic schools in the United States.
Richard J. Baron, MD, president and CEO of the ABIM Foundation referred to the ACA’s list as a way to “reduce waste and overuse in our health care system.”
ACA’s list features the following five recommendations:
- In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain.
- Do not perform repeat spinal imaging to monitor patients’ progress.
- Avoid prolonged or ongoing use of passive or palliative physical therapy treatments (such as heat, cold, electrical stimulation and ultrasound) for low-back pain unless they support the goal(s) of an active treatment plan.
- Do not provide long-term pain management without psychosocial screening or assessment for possible related psychological disorders, most notably depression and anxiety.
- Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.
The list is part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation and Consumer Reports®, which they say encourages conversations between patients and their clinicians about what care is really necessary and appropriate.
According to the Press Release: “To date, nearly 100 health care groups have participated in the Choosing Wisely® campaign to create lists identifying specific tests and procedures that evidence indicates may not always be necessary. ACA is the first chiropractic group to join the campaign.”
The Press Release also asserts that chiropractors focus is on musculoskeletal disorders such as back pain, neck pain, pain in the joints of the arms or legs and headaches through spinal manipulation.
There is no mention of vertebral subluxation or specific adjustments to reduce or correct them in the press release.
