HPU Bulletin: New Chiropractic Quality Standard for Headache
HPU Bulletin: New Chiropractic Quality Standard for Headache
The Royal College of Chiropractors’ Health Policy Unit has announced the publication of a new quality standard which covers the chiropractic assessment and management of adult patients presenting with headache.
Headaches are one of the most common health complaints, with most people experiencing them at some point in their life. The World Health Organization (WHO) reports that almost half of all adults worldwide will experience a headache in any given year. In the Global Burden of Disease Study 2017, headache disorders were the second most prevalent condition worldwide, as well as the second highest cause of years lost due to disability (YLD).
In the UK, migraine headache occurs in 15% of the adult population, with around 200,000 individual episodes estimated every day, resulting in high levels of disability and work absence, as well as having a significant impact on the wider economy. Episodic tension-type headaches affect 80% of people at some time, and are chronic (having more days with a headache than without one) in up to 3% of the population. Medication-overuse headache is the third most common cause of headache, affecting up to 2% of adults. Despite these figures, headache is under-estimated, under-diagnosed and under-treated, and remains a major public health concern.
Chiropractors regularly see patients that present with headache, often having not been seen by any other healthcare professional, and with no diagnosis having been made. Chiropractors have the skills and competencies to assess patients in order to diagnose most primary headaches, identify secondary headaches that require further investigation and, importantly, recognise the red flags that indicate a medical emergency.
As well as having a role in the management of some primary headaches and a few secondary headaches (in particular cervicogenic headaches), chiropractors also play an important public health role in providing support and advice to patients, signposting and making appropriate referrals.
There are a wide range of different patient presentations associated with headache and the management in each case will be different, requiring an individualised approach. The quality statements that comprise the new Headaches Quality Standard are therefore general but, nevertheless, provide aspirational but achievable markers of high-quality, cost effective patient care.
Given the chronic nature of many headaches, where appropriate, the Headaches Quality Standard should be read in conjunction with the chiropractic quality standards on “Chronic Pain” and “Supportive Self-Management in Chronic Care”, both also published by the Royal College of Chiropractors.
All the RCC’s Chiropractic Quality Standards are available for download here in full and abbreviated versions. Note that a separate copy of the Headache Assessment & Management Flowchart, which forms part of the full version of the Headaches Quality Standard, is available on the same webpage.
Assuring safe chiropractic practice during the Covid-19 pandemic
With the R value of covid-19 falling below 1, active introduction of test, track & trace, and essential PPE becoming more accessible, the RCC recognises that it may now be feasible for some chiropractors to decide that, in their professional opinion and depending on their individual circumstances, they are able to offer face-to-face care, for some patients, that meets an appropriate safety threshold.
The RCC advises that it is important for every chiropractor to engage in a stringent risk management process in order to establish the special culture of safety required in clinics during the covid-19 pandemic, and a new RCC document outlines the key requirements of such a process.
Planning for the provision of safe chiropractic care during the Covid-19 pandemic
In notices issued on 24th March 2020 and 9th April 2020, the Royal College of Chiropractors (RCC) advised chiropractors to stop seeing patients in person and clinics to remain closed in order to comply with government guidance on social distancing.
This government guidance has not changed, and the RCC’s advice for clinics to remain closed for face-to-face care has not changed. However, the RCC has issued guidance to assist chiropractors in recognising what is required from a risk management perspective in order to prepare and plan for the provision of face-to-face chiropractic services as the pandemic continues.
Advice to chiropractors regarding clinic closures
The government has advised this evening that while current measures to curb the spread coronavirus are starting to have an impact, it is too early to lift restrictions. Thus, further to advice issued on 24th March 2020, the Royal College of Chiropractors continues to advise chiropractic clinics to remain closed for face-to-face consultations, until further notice.
Coronavirus (Covid-19): Information and guidance for clinics
As from today – Tuesday 24th March 2020 – the Royal College of Chiropractors advises chiropractic clinics to close for face-to-face consultations, focusing instead on providing remote services for the next 3 weeks, i.e. until Tuesday 14 April, in the first instance.
RCC Research Bulletin: Spinal manipulation and the immune system
A new RCC research bulletin, available here, explains that:
- There are no clinical trials of the effectiveness of SMT on enhancing immunity to infectious diseases
- A few published studies report cellular/molecular responses to SMT in vitro, however these are contradictory and offer no evidence of an overall likely pro-immune, clinically-relevant effect in patients
- There has been no systematic appraisal of the quality of the studies in this field
- There is no evidence enabling claims to be made for effectiveness of spinal manipulation on immunity
Information for RCC event delegates regarding Coronavirus (Covid-19)
We expect delegates at our events to follow the Public Health England (PHE) guidance regarding Covid-19. Thus, those who have travelled to the UK from specific locations identified by PHE (including, but not limited to, Hubei province in China and lockdown areas in northern Italy) must stay indoors and avoid contact with other people even if no symptoms are present. For a wider range of locations, the same applies if symptoms are present.
Please refer to the PHE guidance if you have recently travelled to the UK from elsewhere, and adhere to the guidance.
Furthermore, if you have reason to believe that you have been in close contact with someone who has coronavirus, you should call NHS 111 and follow the guidance provided.
If following PHE or NHS guidance requires you to self-isolate, please contact us to let us know. Under these circumstances you must not attend our events.
Contact us at: T: 01491 340022 | E: email@example.com
Coronavirus (Covid-19): Information and guidance for the public and Primary Care
Public Health England (PHE) pulishes regularly updated information for the public on the outbreak of coronavirus, including the current situation in the UK and information about the virus and its symptoms.
PHE has also produced helpful guidance for Primary Care.
The UK Healthcare Regulators have published this joint statement.
Quality Standard Consultation: Headaches
The RCC has opened a consultation on a new Headaches Quality Standard and are seeking the views of all stakeholders including interested organisations, chiropractors, other healthcare professionals, patients and the public. Comments are invited on any aspect of the document including its relevance and applicability to the chiropractic profession, the achievability of the standards described in the quality statements, the utility of the quality statements in terms of promoting best care, the document’s accuracy and validity in terms of the evidence base and the clarity of the content to practitioners, patients and other stakeholders.
Any comments must be submitted by the deadline of 12 noon on Monday 9th March 2020 using the comments form provided below. Comments will not be published but will inform the development of the final version of the quality standard which will be widely publicised.
The draft Headaches Quality Standard is available here
The comments form can be downloaded here
Inquest into the death of Mr John Lawler
The Royal College of Chiropractors (RCC) was deeply concerned to learn of the death of Mr John Lawler, and our thoughts are with his family.
Chiropractic practice is regulated by the General Chiropractic Council (GCC) and, following the recent coroner’s inquest, it is now appropriate for the details of this sad event to be considered by the GCC’s Investigating Committee. We are confident that the GCC will consider the case swiftly and appropriately.
It is vital that the profession learns from this, and we intend to work with the GCC and the wider profession to help ensure that this is the case.