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.

HPU Bulletin: New Chiropractic Quality Standard for Osteoporosis

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HPU Bulletin: New Chiropractic Quality Standard for Osteoporosis

The Royal College of Chiropractors’ Health Policy Unit is pleased to announce the publication of a new quality standard which covers the chiropractic assessment and management of patients with osteoporosis and those at risk of osteoporotic fracture.

This quality standard is specific to the environment in which chiropractic care is provided; a setting that is often less constrained by time and resource limitations than other healthcare settings, and where the physical nature of some therapeutic interventions means that understanding a patient’s bone health is of particular importance. Patients present to chiropractors with a wide range of different complaints and (whether or not related to their presenting condition) the presence of osteoporosis, an osteoporotic fracture or major risk factors of osteoporosis should be a consideration.

Chiropractors have the skills and competencies to identify those patients with significant risk factors prior to the potential deterioration in bone density, and to provide early preventative support and advice. Fractures due to osteoporosis are a significant and growing public health concern and chiropractors are well-placed to identify those at risk, support them to make the necessary lifestyle and practical changes to help limit that risk, and to make appropriate referrals for further investigations and management. This embraces best practice in relation to the public health responsibilities of primary healthcare practitioners.

Vertebral fractures are the most common osteoporotic fracture although up to 70% do not come to medical attention and thus remain undiagnosed. Patients with these fractures often present to chiropractors with an increased kyphosis, loss of height and back pain. Given that vertebral fractures are a powerful predictor of further fracture, chiropractors have an important role to play in identifying and managing these patients, including making appropriate referrals, in an attempt to reduce the risk of further fractures.

Due to the prevalence of osteoporosis, increasing numbers of patients that present to chiropractors have already been diagnosed and are taking medications for the condition. Depending on the circumstances, chiropractors may have a multi-disciplinary role to play in co-managing these patients by providing conservative, non-pharmacological care, as well as communicating with the patient’s GP or other healthcare professionals.

Many different patient presentations are associated with osteoporosis, from those who simply have a number of positive risk factors to patients in severe pain having suffered a recent fracture, and the exact management will be different in each case. Therefore, the quality statements that make up the new quality standard are general but, nevertheless, provide achievable markers of high-quality, cost-effective patient care.

The RCC’s Chiropractic Quality Standard for Osteoporosis is available for download here in full and abbreviated versions. A separate copy of the Osteoporosis Assessment and Management Flowchart, which forms part of the full version of the document, is available on the same webpage.

HPU NG127 NICE guidelines

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HPU Bulletin – Suspected neurological conditions

Suspected neurological conditions: recognition and referral
NICE guideline [NG127]

Published this month, NICE Guideline NG127 covers the initial assessment of symptoms and signs that might indicate a neurological condition. It helps healthcare professionals working in primary and secondary care identify people who should be offered referral for specialist investigation.

The guideline, which gives recommendations for people aged 16 and over, as well as children and young people aged under 16, and includes a helpful interactive flowchart for a wide range of neurological conditions, will provide a useful evidence-based resource for chiropractors.

Musculoskeletal core capabilities framework

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HPU Bulletin - Musculoskeletal Core Capabilities Framework

Released this week, the Musculoskeletal core capabilities framework for first point of contact practitioners is essential reading for chiropractors. Published by NHS England, Health Education England and Skills for Health 2018, the Framework was developed with the Arthritis and Musculoskeletal Alliance (ARMA), of which the RCC is part, and a range of other stakeholders across the whole MSK sector. See here for details.