The Romberg test is a neurological procedure used to assess balance and can be used to gauge a patient’s risk of falling. Unfortunately, the test itself is a fall risk. The fall risk is not huge, and falls are not frequent. However, I have encountered a few situations that have influenced how I use and teach the test.
Coming Soon to a Hospital Near You
Imagine chiropractic care as a pain management option at hospitals nationwide. Not as far-fetched as you might think now that The Joint Commission, which currently evaluates and accredits more than 21,000 health care organizations and programs throughout the U.S. – including nearly 90 percent of all U.S. hospitals – has issued revised pain assessment and management standards.
The revised standards,1 effective Jan. 1, 2018, require the commission's accredited hospitals to "provide nonpharmacologic pain treatment modalities" as a necessary performance element. Chiropractic is included among the potential nondrug treatment options hospitals can utilize to meet the standard, as the commission's 2015 revision stipulated the inclusion of chiropractic care when it first defined nonpharmacologic approaches to pain management:
"Both pharmacologic and nonpharmacologic strategies have a role in the management of pain ... strategies may include the following: Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavior therapy." [Italics added]2
The 2017 revised standards do not prohibit commission-accredited hospitals from pharmacologic approaches; however, the standards emphasize safe opioid and non-opioid prescribing and use, patient education on pain management plans of care and the potential side effects of treatment. The standards also make pain assessment and pain management "an organizational priority" to be adopted by hospitals.
More information about The Joint Commission is available here.
Editor's Note: The Joint Commission's revised standards represent a continuing trend by health care organizations toward nondrug pain management, and away from opioids and other drugs. For example, read "Insurance Win in Rhode Island" in this issue to learn how a bill signed by the governor will give chiropractic a clear role in helping manage the opioid crisis.
References
- "Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals." Perspectives (official newsletter of The Joint Commission), July 2017;37(7).
- Clarification of the Pain Management Standard. Joint Commission, effective Jan. 1, 2015.