Rehabilitation is a growing area of chiropractic. It's an opportunity to offer patients a valuable service while targeting a niche in the marketplace. However, starting a rehabilitation program without the appropriate due diligence adds to a doctor's risk.
by Mario Fucinari, D.C. in Clinical Risks on Thursday, April 27, 2017
In a rehabilitation program, if your patient is not properly screened for health risks and exercise readiness, you may be held liable in the event of a bad outcome. With screening, however, you can prescribe an effective and correct course of treatment—one that is necessary and safe.
One way to do this is by using a self-administered evaluation, such as the Physician Assessment Readiness Questionnaire (PAR-Q).* The PAR-Q is easily incorporated into intake forms because it includes seven simple “yes” or “no” questions to be answered by the patient. The questions include:
- Has a doctor ever told you that you have a heart condition and physical activity should only be undertaken at the recommendation of a doctor?
- Do you feel pain in your chest during physical activity?
- In the past month, have you had chest pain that occurred when you weren’t doing physical activity?
- Do you ever lose consciousness or lose your balance because of dizziness?
- Do you have a bone or joint problem that could worsen by a change in your physical activity?
- Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
- Is there any other reason you should not do physical activity?
If the patient answers “yes” to any one question, the response should be discussed with the patient and taken into account in the plan. If the patient answers “yes” to two questions, an EKG may be indicated to rule out cardiovascular disease. If the patient answers “yes” to three or more questions, a cardiologist should be retained to clear the patient for any rehabilitation exercises.
Many D.C.s are intrigued by the idea of specializing in rehabilitation, but before taking this step make sure to screen patients appropriately.
Resources for Screening Rehabilitation Patients
When taking a patient’s history, especially in a rehabilitation case, it is imperative to rule out the red flags of serious disease. These include:
- Age <20 or >50
- Trauma related to pain
- History of cancer
- Night pain
- Fever, chills, night sweats, nausea, vomiting, fatigue and diarrhea
- Weight loss
- Pain at rest
- Corticosteroid use
- Recent infection
- Generalized systemic disease (diabetes)
- Failure of four weeks of conservative care
- Cauda Equina Syndrome
- Saddle anesthesia
- Sphincter disturbance
- Motor weakness in lower limbs
Screening Protocols for Rehab Patients
It’s also important to be aware of existing screening protocols for patients in rehabilitation. The following are some of the organizations that make these available:
- The American College of Sports Medicine, www.acsm.org
- American Heart Association, www.americanheart.org
- American Association of Cardiovascular and Pulmonary Rehabilitation, www.aacvpr.org
* Patient Assessment Readiness Questionnaire (PAR-Q), copyright Canadian Society for Exercise Physiology, www.csep.ca