Dynamic Chiropractic Canada – March 1, 2009, Vol. 02, Issue 02

Exploring Hospital-Based Chiropractic

Our Experience in Vancouver General Hospital's Combined Neurosurgical and Orthopaedic Spine Program Outpatient Clinic

By Brad Yee, DC, FCCSS(C) and David Olson, DC

We had the fortunate opportunity to be asked by Dr. Paul Bishop to participate in part of his Chiropractic Hospital-Based Interventions Research Outcome Study, otherwise referred to as the C.H.I.R.O. Study. Along with Drs. Don Nixdorf and Heather Hoskin, we formed a team of four chiropractors providing chiropractic treatment to patients with acute lower back pain at Vancouver General Hospital's Combined Neurosurgical and Orthopaedic Spine Program Outpatient Clinic.

This research study was funded by a $200,000 research grant awarded to Dr. Bishop from WorkSafe B.C., British Columbia's workers' compensation board. The goal of the study was to determine if clinical guideline-based treatment, which included chiropractic spinal manipulation, was more effective than usual family physician-directed medical care for patients with acute lower back pain.

All of the chiropractors who worked with Dr. Bishop in the study were awarded treating privileges at the Vancouver General Hospital. (This process was facilitated by Dr. Bishop.) As part of our application for privileges, we were required to submit proof of malpractice insurance and a letter from the College of Chiropractors of B.C. confirming that we were in good standing. Privileges were approved after further review by the Hospital Ethics Committee.

All study patients were initially screened by Dr. Bishop to ensure that they met the eligibility criteria for the study. They were then randomized to receive treatment through their referring family physician ("usual care") or to receive "study care," which included a component of chiropractic spinal manipulation administered in the hospital. Prior to seeing the patients for the first time, we were provided with a consultation report from Dr. Bishop, the referring doctor's report, as well as any special test results including CT, MRI or other lab results.

After reviewing the reports, we met the patient and took a complete history. We examined the patients using a standardized physical examination procedure, which included focused neurological examination, range-of-motion and orthopaedic testing. A chiropractic evaluation for spinal joint fixations was also carried out.

Our protocol was to treat the patients with acute lower back pain up to twice a week for four weeks. Clinical charting was standardized and became part of the patient's permanent hospital record. Thus, accurate charting, including the history, subjective observations by the patient, objective findings (e.g., neurological, orthopaedic and chiropractic testing), and treatment provided, were recorded for each chiropractic hospital visit. All of these findings were entered into a database by Dr. Bishop's research staff.

We were excited at the prospect of treating patients in a hospital setting The treating chiropractors were given a private office in the Spine Program Outpatient Clinic to conduct paperwork and were given access to the digital radiographs and other imaging studies (CT or MRI scans) on the hospital computer network. Treatments were provided in a treatment room using a modified surgical orthopedic bed. Additionally, we were assisted by Dr. Bishop's research and clerical staff, who arranged all of the patient appointments and any other assistance we needed, including the collection of our professional fees for each treatment.

After completing our part of the study, we were apprehensive about the results. Although most of our patients said they felt better, and objectively had improved, we were unsure how the usual care group had done. Our results showed that the group of patients who received guideline-based care that included chiropractic spinal manipulation had clinical outcomes that were superior to family physician-directed care.

Finally, in addition to providing treatment to the C.H.I.R.O. Study patients, we participated in spinal rounds with Dr. Bishop. We would meet in the early morning and then be presented with cases and discuss the pathology and treatment options. This was a very interesting part of our experience, since hospital spine cases are sometimes more complex than those that normally present to our community offices.

Overall, it was a great experience. Meeting spine physicians and surgeons and discussing cases with them reassured us and validated our own private-office clinical examination and treatment procedures. The results of the C.H.I.R.O. Study have provided an example of how a hospital-based chiropractic clinic can be an effective addition. We are interested to see the results of Dr. Bishop's additional C.H.I.R.O. studies and in particular, those that are using the C.H.I.R.O Study model in other hospital-based spine programs. With the opening of the new ICORD Spine Centre at Vancouver General Hospital, we look forward to further opportunities to work with Dr. Bishop in other aspects of his ongoing C.H.I.R.O studies and with his team of spine physicians, surgeons and research staff .

Dr. Brad Yee graduated from Palmer College of Chiropractic West. He has served as director of the British Columbia Chiropractic Association, president of the Sports Medicine Council of British Columbia, and president of the British Columbia College of Chiropractors.

Dr. David Olson is a graduate of Canadian Memorial Chiropractic College. He has served on the board of directors of the British Columbia Chiropractic Association and the board of governors of CMCC.

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