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Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
June, 2011, Vol. 11, Issue 06
Models and Evidence-Bases
By Keith Eric Grant, PhD, NCTMB
The techniques we use as massage therapists are increasingly coming under scrutiny and review. To an extent, this is part of a general movement in health care to review both the effectiveness of interventions and to compare what is actually done in practice with what accumulated evidence suggests would be the "best course".Two reports from the Institute of Medicine out this year underline this review: "Clinical Practice Guidelines We Can Trust" and "Finding What Works in Health Care: Standards for Systematic Reviews". The motivation from this introspection was noted by Joseph Padula in his blog "Managed Care Matters" — even many medical guidelines have had little or no solid evidence behind them, often resulting in less than optimal treatment.
In part also, the scrutiny of massage techniques and conceptual models behind the techniques stems from a cohort of massage educators looking to frame a more sound basis for massage therapy as a component of health care and to bring what's being taught into agreement with modern knowledge of anatomy and physiology. This has turned into an ongoing, international discussion across multiple social media: Facebook, Twitter, and ABMP's "Massage Professionals" forums, in particular.
Looking at evidence requires asking two types of questions; questions that I believe are separable. First, are there specific conditions for which we have evidence that massage techniques provide an effective treatment or co-treatment? If so, what can we say about the reliability of the evidence? Is it supported by research in addition to anecdotal (narrative) observations? In the best of possible worlds, we would like research and anecdote to reinforce each other and add to our insights. Enkin and Jadad provide a context for this delicate process of integrating experience and research.
Those who really follow the principles of evidence-based health care, "the conscientious and judicious use of current best evidence from clinical care research to guide health care decisions," understand that conscientious and judicious use does not mean blind adherence. They are making efforts to integrate research evidence with other types of information, values, preferences, resources and circumstances. Enkin and Jadad also caution about the interplay of belief with anecdotal "evidence," especially when anecdotes and research disagree, leaving the clinical practitioner to face a paradox.
Despite its low ranking in the evidence hierarchy, anecdotal information exerts a disproportionately powerful influence on clinical thinking and behavior. The paradox was well described by William Asher: "If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, your patients are much better, and your income is much better too... It is an almost insoluble problem, and the majority of worth-while doctors are driven to a compromise in which they muster enough genuine belief in their treatment to keep their patients happy and maintain their own respect, while preserving enough doubt to admit their inadequacy during transient bouts of uncomfortable honesty."
It's in trying to resolve the interplay between research and clinical anecdotes that we find the second kind of question. Do we have an explanation for the effectiveness of our techniques that doesn't violate laws of physics and is in accord with modern knowledge of anatomy, physiology and neurology? I explicitly add neurology because our body is not just physical. Our brain does an amazing computational feat in taking the myriad of sensory signals as input and providing us with a body sense as output. This second type of question brings us into the realm of conceptual models or maps for the actions of our techniques. Any such model is an approximation of reality. We can further subdivide questions about such a map into: "Is it useful?" and "Is it a correct approximation?"
Gregory Bateson, in "Form, Substance and Difference," from Steps to an Ecology of Mind (1972), elucidates the essential impossibility of knowing what the territory is, as any understanding of it is based on some representation: "We say the map is different from the territory. But what is the territory? Operationally, somebody went out with a retina or a measuring stick and made representations which were then put on paper. What is on the paper map is a representation of what was in the retinal representation of the man who made the map; and as you push the question back, what you find is an infinite regress, an infinite series of maps. The territory never gets in at all. [...] Always, the process of representation will filter it out so that the mental world is only maps of maps, ad infinitum."
Elsewhere in that same volume, Bateson points out that the usefulness of a map (a representation of reality) is not necessarily a matter of its literal truthfulness, but its having a structure analogous, for the purpose at hand, to the territory. Bateson argues this case at some length in the essay "The Theology of Alcoholics Anonymous."
To paraphrase Bateson's argument, a culture that believes that common colds are transmitted by evil spirits, that those spirits fly out of you when you sneeze, can pass from one person to another when they are inhaled or when both handle the same objects, etc., could have just as effective a "map" for public health as one that substituted microbes for spirits. While treatments of the individual would differ between the two models, actions such as isolation and quarantining would not.
Our challenge as a health care profession in the modern world comes in the way we address these questions, identifying areas needing research, filtering out disproved myths and ensuring the transfer of knowledge into practice.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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