The Role of Reassessment The Clinical Audit Process

Dynamic Chiropractic – July 1, 2010, Vol. 28, Issue 14 The Role of Reassessment: The Clinical Audit ProcessBy Craig Liebenson, DCPatients want relief of symptoms. The traditional biomedical approach focuses on ruling out red flags ofserious disease and providing symptomatic relief. Unfortunately, the biomechanical source of symptoms isleft undetected, leaving the patient at risk for a recurrent clinical problem. The modern functional approachbegins with a thorough history of the relationship of activity to pain. This is followed by a functionalexamination designed to capture two distinct categories of positive findings: the movements that are painfuland the movements that are painless but have abnormal motor control (AMC). International guidelines have summarized the modern evidence-based approach to musculoskeletal pain(MP) management by stating, "The goal of care should shift from removal of symptoms to improvement in1activity intolerances related to symptoms." A within-session goal is reduction in mechanical sensitivity10,32-33(MS) as uncovered during the examination. The means of care typically are identified by finding the chief AMC functional deficits the patient has thatare related to their activity intolerances. Modern MP management shifts the focus from merely treatingsymptoms to restoring function in those activities that are most impaired. This is particularly valuablebecause leading indicators of ongoing disabling symptoms include the belief ...