The Use of a Numerical Point System in the Assessment of Clinical Progress in Patients under Subluxation-Based Chiropractic Care: A Case Study
Patrick L.Vanquaethem, D.C. and James L. Gould, D.C.
Journal of Vertebral Subluxation Research ~ Volume 2 ~ Number 2 ~ Pages 1-10
This case study describes the first stage in the evolution of a Numeric Point System reflecting a Numeric Index and visual depiction of patient progress. The structure of the System embodies four categories which are considered “doctor active” as the results are derived from tests conducted by the practitioner. The categories, comprised of a total of 28 different tests have been categorized into the areas of Neuromuscular, Kinesiological, Orthopedic/neurological, and Pain. These categories are assigned points based on aberrant and/or abnormal findings. Coupled to this assessment is a separate self-report, or “patient active” response to questions concerning health status, current pain or discomfort, and physical function. The “patient active” responses are reported on a visual analog scale and later quantified. The practitioner’s Numeric Index based on the four categories, and the patients self-report collectively form the Numeric Point System. The tests and patient responses are administered as an initial examination followed by periodic re-examinations. This approach serves as one form of quality control for the practitioner to assess the outcomes associated with the formation of a clinical impression and plan of care established for the patient. By coupling the patient’s self-perceptions with clinical findings, a link is made between the value of the tests performed and the care received. Thus, the patient and practitioner have a quantified, visual reflection of progress, or lack thereof, associated with the subluxation-based chiropractic plan of care. In the present single subject report, the patient received an initial examination and five reassessment examinations. The level of progress is reported in a layered fashion such that it can be viewed collectively, with all categories consolidated, or more specifically by individual test. It is believed that this approach contributes to the holistic nature of subluxation-based chiropractic care, as well as serving as a means of providing quantifiable assessment data reflecting the outcomes of patient care. Further study is underway to enhance the Numeric Point System by measuring the reliability of the components of the four assessment categories, and evaluating the significance of progressive changes over time through appropriate statistical analyses.
Key Words: Subluxation, chiropractic, Numeric Point System, Numeric Index, health outcomes assessment, reassessment, plan of care, clinical impression, visual analog scale, self-assessment