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Outcome Assessments

Differential paraspinal dermothermography and spinal balance testing are used post-adjustment to verify relief of nerve interference. While most clinicians post-test the patient immediately after the adjustment and a required resting period, some practitioners defer the post-test to the next visit. During the corrective phase of care it is common to test the patient for the return of nerve interference at intervals of twice weeky for at least 6-8 weeks, and Dr. Blair did not hesitate to insist that the patient be tested at this frequency for three to 18 months initially, depending upon the initial severity and complications of the case. Responsible case management past the initial corrective phase of care will encourage the patient to return for testing at about monthly intervals for life, since the subluxation may return at any time with or without identifiable injury and with or without immediate symptomatic manifestation. To instruct the stabilized patient merely to return on a symptomatic basis is to court the loss of progress achieved.

Comparative A-P Open Mount and flat Lateral Cervical views may be made at an interval of weeks to months after the first adjustment to assess expected changes in the cervical curve, cervical scoliosis, head tilt, lower cervical angulation, or apparent rotation. In difficult cases or where the initial misalignment was large or complex, comparative articular study views may also be made for comparison. Post -adjustive spinographs are not considered a routine part of the system, however, and many practitioners prefer to reserve the patient exposure against possible future injuries.

Probably the most important outcome measure of all is a less formal one: How long does the patient hold the adjustment? Taking into account the patient's age and condition, severity and chronicity of the injury, degenerative changes, activities, and lifestyle, the failure of a patient to hold the adjustment and remain free of chiropractic neurological signs for significant continuous periods of time (at least weeks to months in the average patient, after the first several weeks of care) may indicate the need to reevaluate the case, except in anomalous situations. Comparative Blair Cervical Series spinographs are justified in such a case.

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My pain is gone! I had resolved myself that this nagging, chronic pain in my neck and shoulders was simply "part of life". Thanks to Dr. Smith's precision Upper Cervical adjustments I am pain free! Many thanks to your mindful approach to the health and well being of your patients.

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Huntington Beach, CA

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