CMQM PRESS RELEASE
“Local chiropractic clinic wins national quality award”
The Plymouth Chiropractic Clinic on Mannamead Rd, Plymouth has been awarded the Clinical Management Quality Mark (CMQM) by The Royal College of Chiropractors.
The CMQM is awarded to chiropractic clinics that demonstrate excellence in terms of operating within a structured and managed clinical environment. Applicants must demonstrate excellence in a range of areas including clinical audit, incident reporting and patient satisfaction.
The award was announced at a ceremony in London on 1st February by Chair of the Royal College’s Health Policy Unit, Dr Mark Gurden.
Clinic Principal Dr Wayne Whittingham said:
“The award of the Clinical Management Quality Mark recognises this clinic’s commitment to operating in a professionally managed environment. The aim of our clinic team is to continually improve and the award encourages us that we are achieving this””
Information for Editors
The Royal College of Chiropractors Press Enquiries
Dr Rob Finch, Chief Executive
Tel: 0118 946 9727
About The Royal College of Chiropractors
Granted a Royal Charter in 2012, The Royal College of Chiropractors or ‘RCC’ (formerly The College of Chiropractors) is an academic membership organisation with over 2800 members worldwide and the following objectives:
- to promote the art, science and practice of chiropractic;
- to improve and maintain standards in the practice of chiropractic for the benefit of the public;
- to promote awareness and understanding of chiropractic amongst medical practitioners and other healthcare professionals and the public;
- to educate and train practitioners in the art, science and practice of chiropractic;
- to advance the study of and research in chiropractic.
Members and Fellows of the RCC have always embraced postgraduate training and Continuing Professional Development (CPD) in the public interest, pre-empting any statutory requirement. The College actively fosters patient and public involvement through its Lay Partnership Group. For more information, visit www.rcc-uk.org.
Chiropractic is regulated by Act of Parliament in the United Kingdom. The Chiropractors Act 1994 gives regulatory powers to the General Chiropractic Council (GCC). The GCC’s register of chiropractors opened in June 1999 and approximately 3000 chiropractors are currently registered. It is illegal for anyone in the UK who is not registered with the GCC to describe themselves as a chiropractor. For more information about the GCC, visit www.gcc-uk.org
Chiropractic is a profession, not a treatment. Chiropractors provide a package of care after taking a detailed case history and performing a thorough examination, which considers all aspects of the presenting complaint. This package of care may include spinal manipulation, physical treatments drawn from all types of manual therapy as well as exercise, muscular therapies and a range of advice on activity, lifestyle and prevention. The most compelling evidence for chiropractic care relates to low back pain, but chiropractors help people manage a range of other conditions. This does not necessarily mean that joint manipulation is used, but that the package of care given by the chiropractor provides relief.
Evidence for chiropractic
There is a range of evidence to indicate that chiropractic care is safe and effective. This evidence includes:
- UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 329:1377
This recent MRC-funded study estimated the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to “best care” in general practice for patients consulting with back pain. All groups improved over time. Exercise improved disability more than “best care” at three months. For manipulation there was an additional improvement at three months and at 12 months. For manipulation followed by exercise there was an additional improvement at three months and at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.
- UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ 329:1381
Spinal manipulation is a cost effective addition to “best care” for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
- European Commission Research Directorate General (2004) European Guidelines for the management of acute non-specific low back pain in primary care
Summary of recommendations for treatment of acute non-specific low back pain:
- Give adequate information and reassure the patient
- Do not prescribe bed rest as a treatment
- Advise patients to stay active and continue normal daily activities including work if possible
- Prescribe medication, if necessary for pain relief; preferably to be taken at regular intervals; first choice paracetamol, second choice NSAIDs
- Consider adding a short course of muscle relaxants on its own or added to NSAIDs, if paracetamol or NSAIDs have failed to reduce pain
- Consider (referral for) spinal manipulation for patients who are failing to return to normal activities
- Multidisciplinary treatment programmes in occupational settings may be an option for workers with sub-acute low back pain and sick leave for more than 4 – 8 weeks
- European Commission Research Directorate General (2004) European Guidelines for the management of chronic non-specific low back pain in primary care (2004)
Manipulation/mobilisation – Summary of the evidence:
- There is moderate evidence that manipulation is superior to sham manipulation for improving short-term pain and function in chronic low back pain (CLBP)
- There is strong evidence that manipulation and GP care/analgesics are similarly effective in the treatment of CLBP
- There is moderate evidence that spinal manipulation in addition to GP care is more effective than GP care alone in the treatment of CLBP
- There is moderate evidence that spinal manipulation is no less and no more effective than physiotherapy/exercise therapy in the treatment of CLBP
- There is moderate evidence that spinal manipulation is no less and no more effective than back-schools in the treatment of CLBP
Recommendation: Consider a short course of spinal manipulation/mobilisation as a treatment option for CLBP.
This review, by Gert Bronfort et al, was published in the journal Chiropractic & Osteopathy in 2010. Commentaries by Professor Scott Haldeman and Professor Martin Underwood accompany the report. In summary, the report demonstrates robust randomised controlled trial (RCT) evidence that the care offered by chiropractors is effective for a wide range of conditions including neck pain, pain associated with hip and knee osteoarthritis and some types of headache.
In 2011, the RCC commissioned a review of manual therapy evidence by Warwick University (‘the Warwick Review’) in order to confirm and update a similar review presented in the UK evidence report (see 6 above) and to extend the range of evidence considered to include non-randomised studies. Compared to the UK evidence report, ratings changed in a positive direction from inconclusive to moderate (positive) evidence ratings in three cases: manipulation/mobilisation [with exercise] for rotator cuff disorder, spinal mobilisation for cervicogenic headache and mobilisation for miscellaneous headache. New moderate (positive) evidence was identified for soft tissue shoulder disorders using myofascial treatments not reported in the UK evidence report. In addition, evidence was identified on a large number of non-musculoskeletal conditions that had not previously been considered by Bronfort, most of this evidence was rated as inconclusive; although moderate (positive) evidence was identified for the use of massage for cancer care
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Its guideline on the management of adults and over 16s with back pain and sciatica was published in November 2016.
The evidence-based recommendations include the following:
- Provide people with advice and information, tailored to their needs and capabilities, to help them self-manage their low back pain with or without sciatica.
- Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica.
- Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica.
- Consider psychological therapies using a cognitive behavioural approach for managing low back pain with or without sciatica.