Question 11144 — health professions

Summary

Mr. Fabrice Le Vigoureux draws the attention of the Minister of Solidarity and Health to the decree published on February 13, 2018 relating to chiropractic training (JORF no. 0037). This decree contains a framework of activities and skills necessary for chiropractors. The intervention framework of this profession is defined by Decree No. 2011-32 of January 7, 2011 which limits their interventions to “acts of manipulation and mobilization manual, instrumental or mechanically assisted, direct or indirect, with or without a force vector, having the sole aim of preventing or remedying disorders of the musculoskeletal system of the human body and their consequences, in particular at the level of the spine, excluding organic pathologies which require therapeutic, medical, surgical, medicinal or physical intervention. However, the decree of 13 February 2018 considers that the profession of chiropractor consists of treating “neuro-musculoskeletal disorders” by means, in particular, of joint mobilization defined as follows: “unlike spinal manipulation, mobilization is not a forced maneuver. Mobilization maneuvers can be either active or passive and are aimed at one or more consecutive joints with the aim of encourage their mobility as completely as possible within the limits of joint physiology. At no time does it involve any sudden movement or acceleration.” By modifying the notion of "musculoskeletal system disorders" in the decree into "neuro-musculoskeletal disorders" and that of "manual mobilization" into "joint mobilization", the decree recognizes intervention skills broader than the rights allocated by the decree with the consequences of sharing an entire field of functional rehabilitation between chiropractors and masseurs-physiotherapists. Until now, the boundaries of the fields of intervention of health professionals were made with regard to the actions carried out. This made it possible to identify the professional according to the act to be performed. As a reminder, chiropractic is a regulated profession but is not a approved profession whose medical acts are registered in the public health code following the opinion of the National Academy of Medicine. The patient's care pathway is more complex since, from now on, the distinction between what is the responsibility of the physiotherapist and what is the responsibility of the chiropractor can only be made with regard to the functional state of the patient, even though no relevant indication in the text makes it possible to place the limit of intervention of one professional in relation to the other. The actions carried out by the physiotherapist and the chiropractor are impossible to distinguish. In addition, this decree establishes a dual regime of access to the same care. Indeed, for the same pathology, the patient will be able to access the chiropractor unconditionally and with direct access, while access to the physiotherapist is subject to obtaining a prescription. Therefore, she asks him if a revision of this decree is possible in order to clarify the activities and skills specific to each of these two professions and thus remedy this legal confusion.

Machine translation from French. The official text remains authoritative.

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