In treating patients who have been injured from a Motor Vehicle Collision (MVC), I frequently end up discussing treatment frequency and durations with the patient’s attorney and/or insurance adjustors. This subject does not have to be subjective or confusing as there are guidelines that have been adopted by the national clearing house and have also been adapted by both the International Chiropractic Association and the Colorado Chiropractic Association.
Before we dive into the specifics about treatment guidelines for chiropractic care, including both frequency and duration, we need to realize that guidelines are “simply guidelines” and each case needs to be dealt with on an individual basis. Guidelines are simply guidelines and the treating providers should make clinically appropriate recommendations for each individual patient.
Probably the most important determining factor in a patient’s treatment regimen depends on the exact injuries the patient has received. I can’t count the number of times I’ve been told by an insurance adjustor or an IME (Independent Medical Evaluator) that the patient simply has soft tissue injuries that should heal in a few weeks; to which I usually reply: “Can you send me some research that backs up that statement?” or “Which specific soft tissue injuries are you talking about?” I have yet to receive one piece of research to support such claims.
All treatment plans need to be driven by a proper diagnosis of the exact injuries the patient has. A soft tissue injury could mean a muscle strain that will heal in a few weeks or it could mean a severe ligament instability that will never heal and is a permanent whole body impairment. Additionally, the brain is soft tissue; how long does it take for a traumatic brain injury to heal?
Point being a specific diagnosis will lead to a more appropriate treatment plan and better outcome.
Grades of Severity of Injury
The Management Guidelines for Whiplash Associated Disorders by the International Chiropractic Association (which as been adopted by the Colorado Chiropractic Association), has met the stringent criteria of the Federal Agency for Healthcare Research & Quality (AHRQ), located at www.guidelines.gov. The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the American Medical Association and the American Association of Health Plans. The purpose of the NGC database is to provide healthcare professionals and providers access to objective, detailed information on clinical practice guidelines and to further the dissemination, implementation and use of those guidelines.
Grades of Severity
Guidelines for both treatment frequency and duration can be determined once the severity of the injury is established. Keep in-mind these are just guidelines and each patient may need less or more care.
Regardless of treatment frequency all patients should have a re-evaluation every 30 days to monitor patient’s progress. If patients are not improving as fast as the treating doctor would like or he/she continues to have symptoms such a radiculopathy the treating provider may decide additional diagnostics are needed such as an MRI. This is also an excellent time to decide if additional treatment from other healthcare providers or specialists is needed.
When it comes to treatment frequency and duration each patient needs to be dealt with on a case-by-case basis but proper diagnosis and routine re-evaluations are critical to ensure the patient gets the most appropriate treatment. There are established guidelines to help guide the treating doctor, but they do not replace clinical excellence and experience. There are many factors that complicate the case and make recovery more difficulty such as old age, obesity, degenerative disc disease, osteoarthritis, etc.
Chris Gubbels D.C.