Recently, I had the pleasure of reading a study by J.D. Cassidy, et al., titled "Risk of Vertebrobasilar Stroke and Chiropractic Care." The study findings appeared in the Feb. 15, 2008 supplement of Spine as part of the report of the Neck Pain Task Force for the World Health Organization's Bone and Joint Decade.
I say it was a pleasure for two reasons.First, the data presented reflected a population-based incidence of vertebrobasilar artery-related stroke no greater for patients who had seen a chiropractor than for patients who had seen a general practitioner. Second, the study so perfectly dovetailed with the information presented in the Association of Chiropractic Colleges' (ACC) DVD, "Cervical Spine Adjusting and Vertebral Artery Issues."
The two-hour DVD presentation was developed by an ACC committee and is presented by Gerard W. Clum, DC, president of Life Chiropractic College West. To be candid, I am not easily impressed, but I was impressed with this project. The information provided is thorough, up-to-date and crisply presented, with an emphasis on the realities of the day-to-day chiropractic office setting.
Based on the information offered, consider the monumental shift in thinking that has occurred in recent years, from vertebrobasilar stroke being a problem caused by the chiropractor to being a problem that walks in your office already underway. In the past, the following scenario was the accepted thought:
- Patient sees a chiropractor.
- Patient gets neck adjusted.
- Patient develops stroke symptoms.
- Chiropractor caused it.
However, based on new information and data, it's much more likely the following occurred:
- Patient has a vertebral artery dissection in progress.
- The dissection produces neck pain and headache.
- Patient seeks care from a chiropractor for neck pain and headache.
- Patient may or may not receive a cervical spine adjustment.
- Patient develops greater symptomatology.
In the past, a considerable number of chiropractors felt this wasn't an important matter, based on the technique they used. They reasoned, "I do not use a high-velocity, low-amplitude thrust, so I don't need to worry about this risk."
Today, we understand this is not about causation. Rather, it's about recognition of the vertebral artery dissection already in progress. In this situation, employing a low-force technique will not insulate you from liability. Instead, it's your ability to be alert to signs and symptoms that might tip you off so you can take appropriate action on behalf of the patient that also will protect you.
I urge each and every doctor of chiropractic to review the ACC video presentation and read the recent Cassidy, et al., article to be more alert to the potential of a VAD in progress presenting in the office. This is also important in that all chiropractors should know the facts, figures and rationale associated with this rare circumstance that has all too inappropriately been left on chiropractic's doorstep.
When I contacted Dr. Clum to congratulate the ACC on its outstanding work, I learned that the association is creating additional resources, including an overview of the subject of informed consent. Recent popular press articles on the subject have brought new attention to informed consent as a key element of quality care and as a basic right of the knowledgeable consumer. I was told the ACC is planning on providing a guide to the development and implementation of an informed-consent procedure in the chiropractic setting. This guide will provide doctors with the key elements that should be addressed. In addition, the ACC is planning a 2008 update on the CVA issue, so be watching for it!
On behalf of the profession, I want to offer my sincerest thanks to the ACC and Dr. Clum for providing this important information and these important tools. According to Dr. Clum, more than 60,000 copies of this DVD-based lecture have been circulated around the world. In fact, a number of chiropractic colleges (Life, Logan, Texas, Northwestern and New York) purchased copies of the DVD and mailed them, free of charge, to their alumni. In case your copy of the DVD has been lying around gathering dust, please find and watch it.
If you were not fortunate enough to receive a copy of the DVD from your alma mater, you can purchase one for the reasonable price of $10. That's just two lattes and biscotti to receive the latest and most up-to-date information available on this critically important issue. If you would like to receive a copy of the DVD, visit www.chirocolleges.org or contact the ACC at (800) 284-1062.
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