by Toronto, March 25, 2004 – The Canadian Chiropractic Association (CCA) today stated its support for key recommendations made by the jury in the Lana Dale Lewis inquest which concluded in Ontario in January of this year. The jury’s recommendations on research and inter-professional collaboration are welcomed said the CCA, and reinforce the value of the many activities already taking place in the chiropractic profession in these areas.
Ms. Lewis died of a stroke 17 days following a neck adjustment by her chiropractor whom she had been seeing for treatment of migraine headaches for approximately eighteen months. The jury in the inquest ruled that the cause of her stroke was “accidental” and made recommendations to the profession regarding research, collaboration, and professional practices. Recommendations were also directed to the Ontario Ministry of Health and Long-Term Care, the Coroner’s Office of Ontario and other health professions.
“The jury’s first recommendation to conduct a study ‘to assess the relationship, if any, between high neck manipulation and stroke’ speaks directly to the profession’s current research agenda,” said CCA president, Dr. Grayden Bridge. “While considerable research has already taken place, the rarity of complications associated with neck adjustment has made this a difficult area to study. Further study can only help to shed more light. In fact, three such studies are currently underway in Canada.”
Three Studies Underway
The Canadian chiropractic profession is currently involved in three studies into neck adjustment. The Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders is an international, multi-centre, multi-disciplinary study in which the Canadian chiropractic profession is involved. Two of the Task Force’s five studies are focused specifically on risks associated with the treatment of neck pain. One of the studies will examine neck adjustment and the other will examine the prescription of non-steroidal anti-inflammatory drugs for the treatment of neck pain. Second, the Chiropractic Neck Study is a case control study to assess the risk of stroke associated with neck adjustment under the direction of Dr. Michael Hill, a neurologist and epidemiologist with the Departments of Community Health Sciences and Clinical Neurosciences at the University of Calgary.
Third, the work of Dr. Walter Herzog, Associate Dean of Research, Faculty of Kinesiology, at the University of Calgary into the biomechanics of neck adjustment is ongoing.
“These are excellent studies that directly address the jury’s recommendations and which will help further inform patient care,” said Dr. Bridge.
Inter-Professional Collaboration
The CCA also expressed strong support for the two jury recommendations directed at fostering inter-professional co-operation and collaboration. A significant area of inter-professional collaboration is in research. The Consortium of Canadian Chiropractic Research Centres (CCCRC) currently has 12 university-based research sites established including the chiropractic research programs at l’Université du Québec à Trois Rivières and the Canadian Memorial Chiropractic College. It has sponsored two Research Chairs in chiropractic – one at the University of Toronto and one at the University of Calgary. The CCCRC has also sponsored four significant inter-professional research symposia since its inception. As well, the CCA is an affiliate member of the international Canadian Cochrane Network and Centre and a member of the chiropractic profession serves on the Executive Committee of the Network. The mission of the Cochrane Collaboration is to prepare, maintain and promote the accessibility of systematic reviews of the effects of health care interventions.
“These inter-professional research alliances speak to the intent of the jury’s recommendations and will further inform the quality, efficacy and safety of patient care,” said Dr. Bridge.
The jury also recommended the establishment of inter-professional committees to “promote constructive dialogue and sharing of information between the professions.” Dr. Bridge noted that such a committee exists in Manitoba and that the CCA supports the establishment of similar committees in all jurisdictions. He also stated the profession’s support for further improvements in patient co-management between doctors of chiropractic and medical doctors and noted that the chiropractic profession is developing materials and guidelines to assist members in taking leadership in this regard.
Clinical Practice Guidelines
Regarding the jury’s recommendation that the profession review and update its current Clinical Practice Guidelines (CPGs), Dr. Wanda-Lee MacPhee, president of the Canadian Federation of Chiropractic Regulatory Boards, advised that the chiropractic profession commenced review and development of new CPGs in 2001. The first new guideline will be on neck pain and is expected to be released for public consultation in the spring of this year. “These new Guidelines are being developed to international standards and the Guidelines Development Committee includes representatives from the medical community and the public,” said Dr. MacPhee.
Informed Consent
“We are pleased to report that action on the jury’s recommendations to obtain written informed consent to treatment and to be advised of both the risk and benefits of treatment has been in place for more than 15 years,” said Dr. Bridge. “All regulated health professions are required in law to obtain informed consent to treatment and the chiropractic profession has been a leader in obtaining written consent.” The CCA also advised that a patient hand-out specifically on neck adjustment has been available to all members of the profession to use in their practices since 1998.
Professional Practices
The jury also made a variety of recommendations regarding specific practices. The profession’s responses are summarized below.
X-Rays: The jury recommended the taking of X-rays before any spinal adjustment. “The use of X-rays carries a risk to patients and should only be utilized when clinically necessary,” said Dr. Bridge. “To take X-rays of every patient prior to adjustment would be irresponsible and contrary to the clinical practice guidelines of all health care professions. This is a recommendation that cannot be implemented.”
Screening: The jury noted that provocative testing to screen for risk factors has not been demonstrated to be of benefit and should not be performed. “The rarity of serious complications has made it hard to determine what factors may be involved,” said Dr. Bridge. “We are hopeful that as research progresses, we will better understand the nature of the association.”
Continuing Education: The profession supports continuing education for all health professions as required by their respective provincial regulatory colleges. The provincial chiropractic regulatory colleges are active in ensuring the provision of continuing education.
Record Keeping: The records of regulated health professionals are subject to legislation and regulation in each province and standards currently exist regarding the clear and appropriate recording of patient treatment.
“The chiropractic profession is committed to providing safe, effective, evidence-based care,” said Dr. Bridge. “Ongoing research, collaboration with other health professions and the evolution of clinical practice guidelines will all enhance our ability to serve patients. We thank the jury for the considerable time they contributed to this inquest and support the general direction of their recommendations. This is clearly demonstrated by the policies, practices and activities of the profession – both past and present.”
For more information, please contact: Maureen McCandless, Director Communications, Canadian Chiropractic Association (416) 781-5656 Ext. 242 or 1-800-668-2076.