The rationale for primary spine care employing biopsychosocial, stratified and diagnosis-based care-pathways at a chiropractic college public clinic: a literature review

Abstract

Current management practices for low back pain have led to rising costs without evidence of improvement in the quality of care. Low back pain remains a diagnostic and management challenge for practitioners of many types and is now thought to be a leading global cause of disability. Beyond many published clinical practice guidelines, there are emerging, evidence-based care-pathways including stratification according to the patient's prognosis, classification-based management, diagnosis-based clinical decision guides and biopsychosocial models of care. A proposed solution for successfully addressing low back pain is to train residents at a chiropractic college public clinic to function as primary spine care practitioners, employing evidence-based care-pathways. The rationale for such is described with expected benefits to patient care, improved financial health of medical delivery systems and the training of chiropractors to successfully fill a niche in the healthcare system.

Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

“…As envisioned by its developers, the pure model calls for the PSC clinician to serve as the initial point of contact for all spine patients who present for care in a primary care setting. 2,3,5 Furthermore, among colleagues of the clinician who provided PSC in this study, there appeared to be variable levels of utilization of the PSC model. Therefore, not all patients seen at site I for care of an SRD actually received PSC.…”

“…1 Primary spine Care (PSC) is an innovative approach to the care of SRDs. 2,3,4,5 PSC is defined as first-line management, case coordination and follow-up of patients with any spine related disorder (SRD), under the direction of a certified Primary Spine Practitioner (PSP).…”

Chiropractic Care for Spine Conditions: Analysis of National Health Interview Survey

“…Since 2005, there have been several commentaries further articulating and providing a rationale for the spine care expert position for chiropractic [2][3][4][5][6][7].…”

The biopsychosocial model and chiropractic: a commentary with recommendations for the chiropractic profession

“…Unfortunately, the extent of implementation does not appear to be substantial. Possibly the most notable educational effort at the chiropractic college level has occurred at a single chiropractic college within a post-graduate primary spine care practitioner residency program [ 55 ]. Murphy has introduced an approach to the primary management of spine related disorders, in his textbook series, in which BPS principles are intimately included [ 56 , 57 ].…”