Current through February, 2024
The following addresses the minimal acceptable clinical
competencies necessary to the practice of chiropractic. They identify the
knowledge, skills, and attitudes required of the non-specialist, primary care
doctor of chiropractic:
(1) History
taking or the element of patient evaluation in which relevant and appropriate
information regarding the patient's status is obtained;
(2) Physical examination, an element of the
evaluation in which information regarding the clinical status is elicited by
selecting and using appropriate instruments and examination
procedures;
(3)
Neuromusculoskeletal examination, the foundation of the chiropractic approach
towards evaluating the patient's health problems that are often associated with
the spine and extremities. The spine and its relationship to nervous system
function are also viewed as important factors in the patient's general health.
A neuromusculoskeletal examination involves the use of:
(A) Inspection, palpation, percussion, range
of motion, and appropriate procedures in a correct, orderly, safe and hygienic
manner; and
(B) Instruments and
equipment in an appropriate, safe, and hygienic manner;
(4) Psychosocial assessment, to recognize:
(A) The interrelationships among the
biological, psychological, and social factors which contribute to or affect
patient behavior and well being and that affect the patient's ability to report
symptoms and comply with or respond to chiropractic care;
(B) The clinical indications for referral to
or collaborative care with appropriate mental health professionals, agencies,
or programs; and
(C) Circumstances
that legally require the reporting of patient information to appropriate
authorities;
(5)
Diagnostic studies, which are those elements of patient evaluation in which
objective data regarding the patient's clinical status are elicited, and which
include the use of diagnostic imaging, clinical laboratory, and specialized
testing procedures. The doctor of chiropractic may:
(A) Perform and interpret, order and
interpret, or interpret appropriate imaging examinations;
(B) Take, process, and interpret plain film
radiographs;
(C) Perform, order,
and interpret clinical laboratory examinations;
(D) Obtain and process laboratory
samples;
(E) Perform, order, and
interpret other relevant procedures indicated by the clinical status of the
patient;
(F) Order or conduct
diagnostic studies with attention to following professional protocol, and
provide appropriate patient instructions and follow-up; and
(G) Record data obtained from diagnostic
studies whether personally conducted or ordered;
(6) Case management which includes:
(A) Developing and recording a patient care
plan, case follow-up, the referral or referral and collaborative care necessary
in the chiropractic management of a patient;
(B) Appropriately and effectively
communicating with the patient as to the health care needs and alternatives to
chiropractic care that may be indicated;
(C) Identifying and initiating appropriate
drugless health care regimen;
(D)
Performing appropriate chiropractic adjustments, manipulations and
mobilizations;
(E) Referring the
patient when clinically indicated, for consultation, continued study, and care;
and
(F) Establishing clear outcomes
for care that can be used to evaluate clinical progress; responding to changes
in patient status or failure of the patient to respond to care and recognizing
when the patient has achieved resolution or maximum therapeutic
benefit;
(7) Adjustment,
which is a precise procedure that uses one or more of the following techniques:
(A) Impulse adjusting or the use of sudden,
high velocity, short amplitude thrust of a nature that the patient cannot
prevent the motion, commencing where the motion encounters the elastic barrier
of resistance and ends at the limit of anatomical integrity;
(B) Instrument adjusting, utilizing
instruments specifically designed to deliver sudden, high velocity, short
amplitude thrust;
(C) Light force
adjusting, utilizing sustained joint traction or applied directional pressure,
or both, which may be combined with motion to restore joint mobility;
(D) Long distance lever adjusting, utilizing
forces delivered at some distance from the dysfunctional site and aimed at
transmission through connected structures to accomplish joint mobility;
and
(E) Controlled force, leverage,
direction, amplitude, and velocity directed at specific articulations.
Adjustive procedures are employed to influence joint and neurophysiologic
function;
(8)
Manipulation of the articulations of the body;
(9) Palpation of specific anatomical
landmarks associated with spinal segments and other articulations; utilization
of palpatory and other appropriate methods to identify subluxations of the
spine and other articulations;
(10)
Adjustive, manipulative, and mobilization procedures which utilize appropriate
positioning, alignment, contact, and execution that accommodate differences in
patient body type and clinical status; and
(11) Removal of subluxations of the
articulations of the human spine and human frame and the adjacent tissues for
the establishment of neural integrity, utilizing the inherent recuperative
powers of the body for restoration and maintenance of health.
