Practice Guidelines Endorsed by ACS
UPDATED MARCH 2011
ACS has endorsed the ICA Best Practices which include an extremely well documented section on Frequency and Duration Recommendations. You can read the guidelines by going to http://www.icabestpractices.org/ ACS has also endorsed the Management of Whiplash Guidelines that have been accepted by the prestigious National Guidelines Clearinghouse. You can access these guidelines at http://www.guideline.gov/summary/summary.aspx?doc_id=15113&nbr=007408&string=chiropractic
ACS has also endorsed Chapter 8 of the Mercy Guidelines for frequency and duration recommendations. These guidelines have also been endorsed by the American College of Chiropractic Consultants (ACCC), website http://www.accc-chiro.com/Newslet9.htm, and are far more liberal than many believe. ACCC certified consultants include Arizona Chiropractic Board Chair Dianne Haydon, DC, former Board Vice-Chair Steven Baker, DC, Arizona ACA Delegate Wayne Bennett, DC, and ASH Vice-President for Clinical Affairs, Thomas E. LaBrot, DC.
In the mid-1990s, ASH Vice-President for Clinical Affairs, Thomas E. LaBrot, DC. wrote a book entitled A Standard of Care for the Chiropractic Practice. It included specific recommendations for number of treatments for non-traumatic and traumatic conditions whether mild, moderate or severe. ACS also endorses these guidelines which are summarized here. The full book is posted in two parts here and here. It is out-of-print. The number of treatments allowed are approximately four times more than ASH allows today under the guidance of Dr. LaBrot.
In Chapter 8, pages 124-126, the Mercy Guidelines summarizes recommendations for care. There are two major subgroups of cases: uncomplicated and complicated. With uncomplicated cases, patients experience a significant improvement within 10-14 days and are seen three to five treatments per week. With complicated cases, symptoms remain unchanged for two to three weeks.
Complicated cases are divided into two subgroups: subacute and chronic. With subacute cases, symptoms have been prolonged beyond six weeks, and passive care in this phase is as necessary, not generally to exceed two treatments per week. Patients are expected to return to pre-episode status in six to sixteen weeks.
With chronic cases, symptoms have been prolonged beyond sixteen weeks, and passive care is for acute exacerbation only. Patients may never return to pre-injury status. Furthermore, supportive care using passive therapy may be necessary if repeated efforts to withdraw treatment/care result in significant deterioration of clinical status.
The Mercy Guidelines also consider the impact of certain historical factors that can affect the time frame for reaching intermediate functional milestones (short term goals) and treatment/care outcomes (long term goals). These factors are:
1. Preconsultation Duration of Symptoms. Pain less than eight days: No anticipated delay in recovery. Pain more than eight days: Recovery may take 1.5 times longer.
2. Typical Severity of Symptoms: Mild pain: No anticipated delay in recovery. Severe pain: Recovery may take up to two times longer.
3. Number of Previous Episodes. 0-3: No anticipated delay in recovery. 4-7: Recovery may take up to two times longer.
4. Injury Superimposed on Preexisting Condition(s). Skeletal anomaly: May increase recovery time by 1.5-2 times. Structural pathology: May increase recovery time by 1.5-2 times.
The Mercy Guidelines also state that statistical descriptors of treatment frequency, such as mean/median/mode, should NOT be used as a standard to judge care administered to an INDIVIDUAL patient. The particular factors of each case will govern the course of recovery and need to be a part of the considerations in assessing clinical progress.
When a state association endorses practice guidelines, there are legal implications. Such endorsement means that the guidelines have achieved general acceptance in the chiropractic community. You will be able to cite the ACS endorsement in your reports and testimony. This will greatly strengthen your position. Call or email ACS for further information about how to use these guidelines in your practice.