Quote Originally Posted by dmitsch View Post
Bob,

These guidelines were externally compiled by:
1. Surveying a sample of members
2. A review of current literature
3. A review of current best practice
4. Review by an expert panel
5. Independent legal advice

They are based on evidence.

Is operationalisation as much of a problem for those physio's who's insurance doesn't have rigid requirements on written consent? Are they the misinformed insurers you're referring to?
A "literature review" as suggested above (as it's not much more than that) is not evidence, it is what is considered a review of normal common practise. Then again it was once normal to used TED stocking post op even though we now know (hoepfully) that they don't really work against gravity when standing and are only actually effective in lying. Yet on a survey of you above listed points 1-5 it might still be suggested that we still use them.

Where does it show in the evidence that informing a patient about the perceived risks of cervical manipulation, and indeed getting them to sign to the "informed concent", show that this reduces the incidence of trauma? I would suggest that this evidence does not exist as an outcome. Rather it might only result in the technique to be discarded as a treatment option and/or if it is used make it that much more difficult because of the psychological state that the client has just been put into when told that there is a risk of death when performing the technique. The guidelines as they are stated at present will either be disregarded by the majority as not really relevent in a legal sense or many will simply discontinue use of the technique.

Either way I still feel for my part that the APA is playing into the hands of the insurers and nothing more. Please do paste of attach any document of relevence that backs up the need for this guideline as something that when used reduces patient risk. I would love to have my opinion educated and even changed if the evidence shows otherwise....