In a four page letter to the Chiropractic Australia Executive Committee, the the Board of the International Federation of Chiropractors and Organizations (IFCO) expressed their concerns regarding their proposed submission to the controversial Choosing Wisely campaign and suggested alternative wording. The response by the IFCO included detailed rationales for each of the changes.
CLICK HERE for a complete copy of the IFCO's document
Ever since the American Chiropractic Association (ACA) adopted the Choosing Wisely standards the ACA has been in the midst of an internal struggle after it became obvious that the radiology standards they adopted are a threat to public health. The Choosing Wisely guidelines were rejected by several chiropractic organizations including: Sherman College of Chiropractic, the Foundation for Vertebral Subluxation, ChiroFutures Malpractice Insurance Program, the International Federation of Chiropractors & Organizations (IFCO) the Illinois Prairie State Chiropractic Association, the Michigan Chiropractors Association and the New York Chiropractic Council to name a few.
Then the anti-subluxation group Chiropractic Australia took it to another level of absurdity with their proposal.
The IFCO made specific recommendations to each of Chiropractic Australia's five guidelines. We include only the original statement by Chiropractic Australia followed by the recommended language from the IFCO.
Please refer to the full IFCO document for detailed rationales.
Chiropractic Australia Q1 – Avoid requesting medical imaging, such as X-‐rays, for non-‐specific spinal pain without indication of a pathological cause.
IFCO recommendation – “Avoid requesting imaging, such as x-‐rays, in one or more spinal region for non-‐specific spinal pain without indication of a pathological cause, recognized clinical indicators of biomechanical alteration attributed to vertebral subluxation, or limited progress in patient care outcomes.”
Chiropractic Australia Q2 – Avoid the use of negative, emotive or ‘fear inducing’ language or behaviour, in practitioner to patient communications.
IFCO recommendation – “Avoid the use of negative, emotive, ‘fear inducing’, derogatory or culturally insensitive language or behaviour during practitioner to patient communications.”
Chiropractic Australia Q3 – Avoid any program of care that is not patient-‐centred and evidence based and does not
incorporate the use of validated outcome measures, especially for long-‐term treatments.
IFCO recommendation – “Avoid any program of care that is not patient-‐centered, evidence informed, and does not incorporate reliable and/or valid outcome measures of patient care in any style of chiropractic management (short or long term). Evidence informed care should include the available peer-‐reviewed evidence, practitioner experience and patient preference.”
Chiropractic Australia Q4 – Avoid using the terms ’vertebral subluxation’ or ‘spinal dysfunction’ as a cause of disease.
IFCO recommendation – “The term ‘vertebral subluxation’ is commonly used within the chiropractic profession to describe an aberrant state of neuro-‐spinal integrity that is associated with altered intersegmental biomechanical and neurophysiological function which may be limited to local, or lead to regional and systemic changes within the individual”
Chiropractic Australia Q5 – Only request 3-‐4 region spinal x-‐rays where there is indication such as serious disease, trauma or for the identification and monitoring of scoliosis.
IFCO recommendation – “Requisition of 3-‐4 region spinal x-‐rays should only be considered where there is clinical indication of serious disease and/or trauma, for medico-‐legal requirement, for further identification of intersegmental and/or gross regional abnormalities of structural integrity or the monitoring of scoliosis progression.”
END
The IFCO's suggested changes to Chiropractic Australia's Choosing Wisely submission is considered to be more in line with the current scientific literature regarding vertebral subluxation, more culturally sensitive and more evidence based.
IFCO’s mission is to protect, promote, and advance chiropractic as a separate and distinct profession dedicated to the detection and correction of vertebral subluxation for the better expression of life.
