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.

Quality Standard Consultation: Headaches

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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

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.

Chiropractic & Manual Therapies gains an Impact Factor

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Chiropractic & Manual Therapies gains an Impact Factor

The Royal College of Chiropractors is delighted to announce that the Royal College’s official journal, Chiropractic & Manual Therapies (CMT), has been included in the Science Citation Index – Expanded (SCIE), under the ‘Rehabilitation’ category. Journals in the SCIE are indexed in Web of Science and also receive an Impact Factor, which is a very significant measure of the high quality of the publication. Given that this decision was made very recently, CMT won’t get an Impact Factor with this year’s release of the Journal Citation Reports, but will receive it in June 2020,

This achievement means that CMT will be the first journal in the world with “chiropractic” in its title to attain an impact factor.

Professor Bruce Walker AM, Editor in Chief, stated that ‘this success is due to the collective efforts of a large group of people who have supported the journal over its long 29-year history. There are indeed too many to mention however, there are some very important contributors to the accomplishment. First, the staff of publishers BMC whose professional stewardship over 14 years has been outstanding, and members of the CMT editorial team, past and present. The editorial board has provided advocacy, reviews and advice regarding the journal that paved the way for success. Authors and peer reviewers are to be acknowledged as well’

Professor Walker went on to thank all who believed in the journal and to the many readers who have accessed articles. The journal is now truly established and, with continued support, will thrive in the coming years and decades.

Osteoporosis Quality Standard Consultation

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Osteoporosis Quality Standard Consultation

The Royal College of Chiropractors has opened a consultation on a draft Osteoporosis Quality Standard and is seeking the views of all stakeholders including interested organisations, chiropractors, other healthcare professionals, patients and the public. You can read the draft document and participate in the consultation here.

Embedding physical activity in the undergraduate curriculum

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Embedding physical activity in the undergraduate curriculum

All healthcare professionals are well-positioned to influence positive lifestyle changes among their patients, and encouraging physical activity is a vital part of helping patients avoid and manage health problems. However, physical activity is not well integrated into undergraduate curricula for medicine and other healthcare professions.

The ‘Embedding Physical Activity’ report and appendices, co-authored by Ann Gates of Exercise Works who gave a keynote address at the Royal College of Chiropractor’s AGM in January 2018, was commissioned by Public Health England (PHE) & Sport England (SE) as part of their Moving Healthcare Professionals Programme, and is aimed at embedding physical activity into undergraduate curricula. It highlights the initiatives of the Chiropractic Schools and the RCC which are working towards better incorporating physical activity into undergraduate chiropractic training and continuing professional development as part of a wider public health initiative.

New NICE Low Back Pain & Sciatica Guidance

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New NICE Low Back Pain & Sciatica Guidance

Today’s publication of the NICE Low Back & Sciatica Guidance was welcomed by the Royal College of Chiropractors. The Guidance recognises the evidence for spinal manipulation which is typically provided by chiropractors as part of an evidence-based package of care including exercise and psychosocial support.
http://bit.ly/2fRmtyp

NICE LBP & Sciatica Guideline

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NICE LBP & Sciatica Guideline

NICE has informed stakeholders that there has been a delay to the publication of the Low Back Pain & Sciatica guideline, which was due to be published on 7 September 2016. Apparently, a large number of comments were received during the consultation phase and so additional time is being taken to ensure that all of the points raised have been considered fully and responded to appropriately. The new publication date has yet to be confirmed.

New Chronic Pain Quality Standard

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New Chronic Pain Quality Standard

The Royal College of Chiropractors has launched a new Chiropractic Quality Standard on Chronic Pain, the latest in a series of RCC Quality Standards that aim to make it clear to patients, the public, healthcare professionals, commissioners and chiropractors what high-quality chiropractic care looks like.

The Chronic Pain quality standard can be accessed here along with all the other RCC quality standards. An associated audit toolkit will be available shortly.

Public consultation on new Chronic Pain Quality Standard

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Public consultation on new Chronic Pain Quality Standard

The RCC is currently consulting on a new Chronic Pain Quality Standard and invites the views of chiropractors, chiropractic organisations, patients and the public 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. Please click here for details.