Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1039
“Ensuring Orthopedic Testing are Objective”
“Just because I thought it was right… doesn’t mean it was” Mark Studin 2019
Over the past few weeks, I have been recording a course on testifying with a legal expert on personal injury. While we were recording the “direct examination” module, he grilled me on what was objective vs. subjective, and it was revealing, eye-opening and truthfully I made him look like a fool based on my knowledge, insight, experience and overall presence on the stand with my academic standing. OK…I lied… he KICKED MY ASS, and I whined like a little girl and needed the bathroom after he was done with me!!!!
At the end of the recording, we established how to ensure that your clinical examination can be considered objective and it came down to 2 words; duplicable & verifiable.
When we discussed the ranges of motion, I explained that I use the standard of the AMA guides, 5th edition, which I was taught in my doctoral and post-doctoral training. My answer was that I utilize a 2-piece digital inclinometer and have the patient do 3 repeats of the range, and they have to be within 10% of each other with only 6 tries to get 3 within that 10%. Duplicable: 3 repeats Verifiable: Digital Inclinometer. That takes the patient's response out of the equation.
What about a Lasegue’s test? My answer was I place my hand under the patients back and feel the muscles for spasticity, and I concurrently observe the patient’s response looking for distress. His answer was that is good, but not bulletproof for objectivity. He suggested I do the test, but 3 times to ensure duplicability.
Now, when I do orthopedic testing, I have my opposite hand on the joint being tested feeling for a reaction that would show a positive response. For each test, there needs to be a separate comment, in macro format, that explains how that orthopedic test was objective.
The is a large part in making your competition irrelevant. NO ONE is doing this simple task and tells the lawyer that you understand there needs while ensuring accuracy in your findings.
Also, we have planned to create an orthopedic testing guide that will include every Macro for every orthopedic test. That will take a few weeks and be available to you shortly, but for now… do it yourself!
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
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