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Can the Chiropractic Profession Find a Road Map to Cultural Authority From Physical Therapists?By Craig Liebenson, DC Chiropractic continues to suffer from an overemphasis on philosophical and hypothetical beliefs while reliable, evidence-based approaches are ignored. Clinical practice and future research should be informed by both experience and evidence. Is our profession striking the right balance between forming hypotheses (retrospective experience) and testing those hypotheses (prospective evidence)? Cultural authority requires that chiropractic shed the image of the charlatan engaged in premature advocacy and overclaim of unreliable, unproven health care beliefs. A road map for this strategy has been refined, to a high degree, by a related health care field - physical therapy.An editorial in the October 2005 Journal of Orthopedic and Sports Physical Therapy (JOSPT) quotes the American Physical Therapy Association's (APTA)'Vision 2020:1,2 "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health. To achieve this goal, APTA's Board of Directors suggests that we should focus our efforts on five key areas: professionalism, direct access, the doctor of physical therapy, evidence-based practice and practitioner of choice. Because a majority of first professional degree programs have now transitioned to the professional doctoral degree and physical therapists can provide direct access care in 39 states, it is clear that we are quickly moving toward the Vision 2020. However, it would be helpful to reflect on where we are as a profession and what it is, exactly, that we want in our journey toward the goals set forth by our national organization." A related article in Physiotherapy Canada gives a historical overview of the evolution of the PT profession, summarized as follows:4
Some Questions for Chiropractors to Ponder
Physical therapists should be commended for their explicit work to improve their ability to care for patients. In summary, they have embraced evidence-based health care; movement disorders; the WHO framework for disabilities and impairments;5-6 peer-reviewed research; interdisciplinary dialogue; and MSc and PhD programs for their best and brightest. These are all areas in which the chiropractic profession can similarly derive benefit. Chiropractic is a leader in the conservative management of NMS conditions. We have always emphasized restoration of function, rather than mere treatment of symptoms. Chiropractic research has evolved by leaps and bounds over the past few decades. However, there are a number of shortcomings which render us vulnerable to such a broad-based, progressive approach as enumerated by physical therapists. Our academic isolation is a major hurdle for us to overcome, as is our undying support for practice management models that do not emphasize evidence-based care and may even be unethical. Another issue is prioritizing our political goals to protectionist actions against PT's scope of practice, rather than quality improvement of our own clinical approach to care. For chiropractic to remain competitive in the health care marketplace, we must benchmark ourselves as evidence-based, patient-centered NMS health care providers.3 Otherwise, we risk seeing even less than the 7 percent of population we currently see. To accomplish this, we should become experts not only at getting people out of pain, but also in showing them how to take care of themselves. Then, we can truly say we are offering patient-centered care. References
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