Guidance concerning chiropractic practice in response to COVID-19 in the U.S.: a summary of state regulators’ web-based information

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Abstract

Introduction

The COVID-19 pandemic led to unprecedented changes, as many state and local governments enacted stay-at-home orders and non-essential businesses were closed. State chiropractic licensing boards play an important role in protecting the public via regulation of licensure and provision of guidance regarding standards of practice, especially during times of change or uncertainty.

Objective

The purpose of this study was to summarize the guidance provided in each of the 50 United States, related to chiropractic practice during the COVID-19 pandemic.

Methods

A review of the public facing websites of governors and state chiropractic licensing boards was conducted in the United States. Data were collected regarding the official guidance provided by each state’s chiropractic licensing board as well as the issuance of stay-at-home orders and designations of essential personnel by state governors. Descriptive statistics were used to report the findings from this project.

Results

Each of the 50 state governor’s websites and individual state chiropractic licensing board’s websites were surveyed. Stay-at-home or shelter-in-place orders were issued in 86% of all states. Chiropractors were classified as essential providers in 54% of states, non-essential in one state (2%), and no guidance was provided in the remaining 44% of all states. Fourteen states (28%) recommended restricting visits to only urgent cases and the remaining states (72%) provided no guidance. Twenty-seven states (54%) provided information regarding protecting against infectious disease and the remaining states (46%) provided no guidance. Twenty-two states (44%) provided recommendations regarding chiropractic telehealth and the remaining states (56%) provided no guidance. Seventeen states (34%) altered license renewal requirements and eight states (16%) issued warnings against advertising misleading or false information regarding spinal manipulation and protection from COVID-19.

Conclusion

State guidance during the COVID-19 pandemic was heterogenous, widely variability in accessibility, and often no guidance was provided by state chiropractic licensing boards. Some state chiropractic licensing boards chose to assemble guidance for licensees into a single location, which we identified as a best practice for future situations where changes in chiropractic practice must be quickly communicated.

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Most cited references 15

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Who uses emergency departments inappropriately and when - a national cross-sectional study using a monitoring data system

Philip McHale, Sara Wood, Karen Hughes … (2013)

Background Increasing pressures on emergency departments (ED) are straining services and creating inefficiencies in service delivery worldwide. A potentially avoidable pressure is inappropriate attendances (IA); typically low urgency, self-referred patients better managed by other services. This study examines demographics and temporal trends associated with IA to help inform measures to address them. Methods Using a national ED dataset, a cross-sectional examination of ED attendances in England from April 2011 to March 2012 (n = 15,056,095) was conducted. IA were defined as patients who were self-referred; were not attending a follow-up; received no investigation and either no treatment or ‘guidance/advice only’; and were discharged with either no follow-up or follow-up with primary care. Small, nationally representative areas were used to assign each attendance to a residential measure of deprivation. Multivariate analysis was used to predict relationships between IA, demographics (age, gender, deprivation) and temporal factors (day, month, hour, bank holiday, Christmas period). Results Overall, 11.7% of attendances were categorized as inappropriate. IA peaked in early childhood (adjusted odds ratio (AOR) = 1.53 for both one and two year olds), and was elevated throughout late-teens and young adulthood, with odds reducing steadily from age 27 (reference category, age 40). Both IA and appropriate attendances (AA) were most frequent in the most deprived populations. However, relative to AA, those living in the least deprived areas had the highest odds of IA (AOR = 0.89 in most deprived quintile). Odds of IA were also higher for males (AOR = 0.95 in females). Both AA and IA were highest on Mondays, whilst weekends, bank holidays and the period between 8 am and 4 pm saw more IA relative to AA. Conclusions Prevention of IA would be best targeted at parents of young children and at older youths/young adults, and during weekends and bank holidays. Service provision focusing on access to primary care and EDs serving the most deprived communities would have the most benefit. Improvements in coverage and data quality of the national ED dataset, and the addition of an appropriateness field, would make this dataset an effective monitoring tool to evaluate interventions addressing this issue.

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Evaluating and managing acute low back pain in the primary care setting.

Steven J Atlas, Richard A Deyo (2001)

Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations.

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Disagreement among health care professionals about the urgent care needs of emergency department patients.

J. Gill, C REESEIV, J. Diamond (1996)

To assess agreement among health professionals with regard to the need for urgent care among emergency department patients. We conducted a chart review of 266 ED patients in an urban teaching hospital. Eight health professionals (four emergency nurses, two emergency physicians, two family physicians) used identical criteria to retrospectively rate urgency. Agreement was measured for all reviewers, as well as among health professionals of the same specialty. Agreement was also measured between one ED nurse's retrospective assessment and the prospective assessments of the triage nurses who had seen the patients on presentation. The percentage of patients rated as needing urgent care by the retrospective reviewers ranged from 11% to 63%. Agreement among the retrospective reviewers was fair (kappa = .38; 95% confidence interval, .30 to .46) and was no better among reviewers of the same specialty. We found only slight agreement between the nurse reviewer's retrospective assessment and the triage nurses' prospective assessments (kappa = 19; 95% confidence interval, .07 to .31). Even when using the same criteria, health professionals frequently disagree about the urgency of care in ED patients. When retrospective reviewers disagree with a prospective assessment of urgency, the potential exists for denial of payment or even lawsuits. Because the subjectivity of urgency definitions may increase disagreement, the development of more objective and uniform definitions may help improve agreement.

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Author and article information

Contributors

Shawn M. Neff:

ORCID: http://orcid.org/0000-0002-8979-8260

Shawn.Neff@va.gov

Journal

Journal ID (nlm-ta): Chiropr Man Therap

Journal ID (iso-abbrev): Chiropr Man Therap

Title: Chiropractic & Manual Therapies

Publisher: BioMed Central (London )

ISSN (Electronic): 2045-709X

Publication date (Electronic): 6 July 2020

Publication date PMC-release: 6 July 2020

Publication date Collection: 2020

Volume: 28

Electronic Location Identifier: 44

Affiliations

[1 ]Martinsburg Veterans Affairs Medical Center, Martinsburg, WV USA

[2 ]Veterans Affairs Nebraska-Western Iowa Health Care System, Grand Island, NE USA

[3 ]Minneapolis Veterans Affairs Medical Center, Minneapolis, MN USA

[4 ]St Louis Veterans Affairs Health Care System, St Louis, MO USA

[5 ]Veterans Affairs Central Iowa Health Care System, Des Moines, IA USA

[6 ]GRID grid.413933.f, ISNI 0000 0004 0419 2847, Veterans Affairs Northern California Health Care System, ; Redding, CA USA

Author information

Shawn M. Neff http://orcid.org/0000-0002-8979-8260

Article

Publisher ID: 333

DOI: 10.1186/s12998-020-00333-6

PMC ID: 7336092

SO-VID: da0f025b-c4f3-4bac-9dc3-aeab3e7f9bf9

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 15 May 2020

Date accepted : 30 June 2020

Custom metadata

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: chiropractic,covid-19,coronavirus disease 2019,2019 novel coronavirus disease,licensure,governing board,regulation,social control

Data availability:

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: chiropractic, covid-19, coronavirus disease 2019, 2019 novel coronavirus disease, licensure, governing board, regulation, social control

Guidance concerning chiropractic practice in response to COVID-19 in the U.S.: a summary of state regulators’ web-based information

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Abstract

Introduction

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Conclusion

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Novel Coronavirus Disease COVID-19

Most cited references 15

Who uses emergency departments inappropriately and when - a national cross-sectional study using a monitoring data system

Evaluating and managing acute low back pain in the primary care setting.

Disagreement among health care professionals about the urgent care needs of emergency department patients.

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