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From the AAOMPT official newsletter:
Articulations
Practice Affairs Corner
William Boissonnault, Academy Practice Committee Chair
No You Don't, Yes We Do, No You
Don't………
The Challenge From Chiropractors
During manipulation legislative debates and negotiations,
Chiropractic organizations frequently express the attitude of ownership;
"Manipulation is ours" is their message. Of course, we respond that
manipulation has been a part of our practice since the 1920s and have
references to prove it. As many of you have experienced, the ensuing
discussion takes on the form of a merry-go-round with no-one willing to
get off the ride. This dialogue represents a good old fashion turf
battle, just the thing legislators DO NOT want to participate in. So,
what are the merits of the argument "No you (physical therapists)
don't," meaning its not a part of our practice and "Yes we do" meaning
it is a part of our practice?
The chiropractor argument is typically based on patient safety
concerns, a concern shared by all health professions no matter the
discussed intervention or test. But many times the patient being at-risk
concern is simply a smoke-screen for the real issue-economics. The
Institute for Alternative Futures recently released a document titled
The Future of Chiropractic Revisited: 2005-2015. This report was
heavily supported by chiropractic communities and all 18 members of on
the advisory panel responsible for the document's content were either
chiropractors or executive directors of chiropractic associations. The
advisory panel was charged with revisiting the analysis and forecasts
focusing on issues and trends in the chiropractic field that were
presented in their previous document published in 1998. Physical
therapists are mentioned in the current document on 26 different pages!
In well over 90% of the notations physical therapists are mentioned in
the context of an economic competitor. For example, on page i of the
Introduction; "The biggest competitive threat will come from physical
therapists."; on page iv "Other providers offer spinal manipulation for
lower back, neck, and chronic pain. DPTs and massage therapists take
over a large percentage of the cash market for back pain."; On page vii
"Chiropractors will face more competition, especially from the growing
number of physical therapists who are pursuing direct access in all 50
states and are upgrading their educational programs to graduate Doctors
of Physical Therapy." On page 13 "Probably the most serious competitive
threat on the horizon is from physical Therapists."; and so on and so
on. No where is it mentioned that they must take action to protect the
patient.
Why should legislators believe our side of the "Yes I do" turf
argument any more than the No side? Do we have evidence from a source
other than the mouths of physical therapists that manipulation is a part
of our practice? Can we find sources beyond our own documents listing
manipulation as an intervention for confirmation of our claim (The Guide
To Physical Therapist Practice, Normative Model of Physical Therapist
professional Education, CAPTE Evaluative Criteria etc.)? The answer is
yes-even the Chiropractors say so! The Future of Chiropractic
Revisited: 2005 to 2015 frequently acknowledges that physical
therapists utilize manipulation techniques. In 2004 the Veterans Health
Administration (VHA) recognized physical therapists as a provider of
manual therapy services including spinal mobilization/manipulation
within the VHA. In 1999 Dr. Tom Gustafson, Director of Center for Health
Plans and Providers, Department of Health and Human Services stated that
physical therapists provide services including manipulative treatment of
the spine and other areas for Medicare recipients. In 1998 a code to be
used by physical therapists reading; "manual therapy techniques
(mobilization/manipulation, lymphatic drainage, manual traction" was
approved by the American Medical Association's Common Procedural
Terminology (CPT) code panel. In 1999 the Virginia Board of Medicine
Department of Health Professions was charged to study spinal
manipulation and the risk of harm to the public. After intense data
gathering, the task force concluded that no limitations regarding the
use of manipulation be placed on physical therapists. Documents and
details of each of the decisions and others are available through APTA
Governmental Affairs. Lastly, and maybe most importantly, the research
provides evidence that manipulation is part of our practice. Dave
Johnson and Mike Rogers published a Letter-to-the Editor in Physical
Therapy Journal (August, 2000) on the topic of spinal manipulation. They
described the AHCPR guidelines on Acute Low Back Pain and the
RAND meta-analysis on low back pain. Of the 27
research papers cited in these two landmark reports, the manipulative
services were provided by physical therapists in 12 of the studies
compared to only 4 for chiropractors! In addition, over the past 10
years physical therapists have been at the forefront of research
initiatives investigating manipulation. Numerous articles authored by
physical therapists can be found in the top refereed health professions'
journals.
When negotiating with chiropractic organizations we should make it
clear who besides us states manipulation is a part of our practice. We
should also make it clear to the chiropractic representatives that we
will share with legislators the documents/articles that refute their
claim that manipulation is not a part of physical therapist practice.
This strategy will not necessarily end the turf battle scenario, but
providing evidence that prominent organizations have concluded that
physical therapists provide manipulation services will only strengthen
our position.
| chiropractor, manipulation |
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