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Chiropractic Research Review

Principles of Joint Assessment

Increased interest in accountability in the health care arena has sparked interest in outcome measures that maximize effectiveness and efficiency of care. Although the chiropractic articular spinal examination is "unparalleled" in the health care professions, the authors of the current study suggest that DCs may benefit from "greater standardization of the approach to the evaluation of joint structure and function leading to the identification of subluxation."

This article emphasizes the importance of conducting an appropriate examination of the patient, including assessment for subluxation.

A systematic approach to evaluating the spine for subluxation is presented using the acronym "PARTS" to represent the various steps:

* Pain/tenderness (spinous percussion and tenderness to pressure);

* Asymmetry/alignment (posture, palpation and x-ray findings);

* Range-of-motion abnormality (active, passive, joint play and end feel);

* Tone/texture/temperature (palpation of skin and muscles); and

* Special tests for specific adjusting technique systems (e.g., therapy localization).

Included is a qualitative review of clinical and scientific literature related to assessment methodologies for subluxation, along with several tables and flow charts presenting data on evaluation procedures.

Conclusion: Utilization of the PARTS examination protocol can document clinical effectiveness of care.

Take Note: The authors note that Medicare has adopted the PART portion of the PARTS physical examination as the new alternative to x-ray for substantiation of spinal subluxation, suggesting that insurance carriers may respond favorably to this type of evaluation.

Bergmann TF, Finer BA. Joint assessment - parts. Topics in Clinical Chiropractic 2000:7(3), pp1-10.
Reprints: (800) 638-8437

Chiropractic Research Review

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