003- The Award Winning CHIRO Research Article

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Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. I hope your holiday shopping is nearly complete. As we head into the middle of December here, we have a few weeks left rounding out 2015. I hope it's been a great year in practice and we're certainly looking forward to 2016. Today we're going to talk about a Spine Journal paper that was published in 2010. Of significant importance is that this paper won the 2010 Outstanding Paper in Medical and Interventional Science, an extremely important award and also very important because this is a chiropractic specific study. That's an award winning study in the Spine Journal. Before we dive into the research, I'd like to say a few words about Rocktape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Rocktape offers the world's best kinesiology tape, pain relief, topicals, mobility tools and functional fitness accessories. New from Rock Tape is Rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. Most importantly, Rocktape is not just a tape company, it's a movement company. Learn more and get access to your medical discount by visiting rocktape.com now back to the research, the spine journal article that we're diving into today. It's chiropractic focused and it's actually called the Chiro Study, meaning the Chiropractic Hospital Based Interventions Research Outcome Study, a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. That's a mouthful, really. The Chiro study took two groups of patients in a real world setting and they prescribed those patients, for lack of a better way to put it, usual care and evidence based care. In the usual care column was physical therapy, nsaids, reassurance and if necessary, narcotic analgesics. In the evidence based care portion, patients received chiropractic manipulation, exercise, NSAIDs as well as reassurance. The authors of the study found that the outcomes clearly support the use of evidence based care, which includes chiropractic as a focal treatment. In the study, the patient age range was 19 to 65, which more than likely is the heart of most of our practices and also the heart of many PCP and internal medicine practices. We all know that improving patient outcomes in the acute phase of entry is imperative because the development of chronic pain often begins with poor outcomes during the acute management. Essentially we don't want to waste time upfront we this study truly exhibits why cooperation and co management of acute back pain can lead to better outcome for patients that are entering their primary care doctor offices. Patients are able to utilize the skill sets of MDs and DCs. I think research on the whole shows that they have the optimal set of circumstances for the highest amount of functional gain. These researchers found the evidence based care group demonstrated significantly greater improvements in reported functioning through six months. Following six months is important. Six months certainly goes far beyond the natural history of any back pain episode and it also starts to talk about long term gains. This isn't just a two week improvement period or a one month improvement period, but they also have significantly greater improvements. The patients in the study with evidence based care including chiropractic care, significantly greater improvements in reported function and function is truly what it's all about for patients. Quality of life for patient centric model the researchers also found the results of this study demonstrated that in equivalent groups of patients with acute low back pain of less than four weeks duration, carefully controlled and comprehensive clinical practice guideline based care was associated with greater improvement in terms of condition specific functioning at 16 weeks. That's really a long way of saying essentially the same thing we said with the first quote. But. But really when you're taking equivalent groups of patients with acute back pain less than four weeks duration of pain and putting them through either a standard practice of care, what they're going to call usual care or evidence based care, it's important to realize that those outcomes may be convergent or divergent at a four week, at a 12 week, at a 16 week or even a six month marker. And to put that in perspective again this this specific piece of research showed that patients receiving evidence based care, including chiropractic had significantly better function at the six month marker as chiropractors. The third quote that I'm going to talk about probably has the most impact for us, can be the most frustrating but I think also truly emphasizes the point of why we need to build the bridges, bridge the gap between other healthcare professions and providers and ourselves really on a personal level in each of our communities, they found. This study follows two previous studies conducted by our group that demonstrated that treatments commonly recommended by primary care physicians are often highly guideline discordant and other studies have demonstrated that PCPs are highly resistant to changing their patterns of practice for managing patients with acute low back pain. I'm going to repeat that quote. This study follows two previous studies conducted by our group that demonstrated that treatments commonly recommended by primary care physicians are often highly guideline discordant. And other studies have demonstrated that PCPs are highly resistant to changing their patterns of practice for managing patients with acute low back pain. Let's let that sink in for a moment. To me, that last line really puts in perspective Perhaps the last 10, 15, even up to 20 years of chiropractic care for patients that we see and treat each and every day. The research, the breadth and depth of the research supporting chiropractic care has grown by leaps and bounds, whether it's in chiropractic focused journals, to the British Medical Journal, Spine Journal, everything in between. But on the whole, very rarely are our offices being flooded by referrals from MDs, PCPs, internal medicine docs and neurologists in our own communities. Even though the research has shown this. To me, this is truly somewhat to do with ignorance. They may not know or be kept up to date in terms of musculoskeletal care, and they might be relying on happenstance and old manners of thought regarding what we do as chiropractors. I think the other big thing that this study shows is generally speaking, primary care physicians are extremely reluctant to refer to new providers. Additionally, the typical referral patterns are even what these researchers would say are highly guidelined, discordant, they're not practicing evidence based care regarding their patients. That's a tough pill to swallow as a chiropractor, especially when we have healthcare profession and treatment options which perhaps are the most safe and show the most efficacy and also show the most functional improvement and quality of life for patients that we see each and every day in practice. And while we know that primary care practices tend to see up to 25% of their practice each and every day are related to spine complaints. But what I take away from the study in that sentence really is about the importance of bridging that gap, the importance of getting out there and building those relationships. Because once you have developed and established that relationship, it should be something that's a referral relationship for many years to come. And when Spine Journal is using chiropractic care as the foundation of their evidence based care for any sort of spine complaint, I think it's high time and certainly the onus is on us as individual practitioners in our community to build those relationships. Truly, our friends and neighbors are counting on it in research such as this, the CAIRO study in 2010. That's an award winning study from Spine Journal that emphasizes the efficacy of chiropractic care and of functional improvement and quality of life, even at a six month marker. These are absolutely imperative studies for us to be able to get out into our communities, share with our family, friends, co workers and members of our community neighbors. But also, this is another foundational component of outreach to your other healthcare providers in your community. By bringing them value and keeping them up to date on the latest in musculoskeletal care, you'll ultimately be positioning your practice as a leader in your community. Not only that, but again, it's about providing value not only to the patients who come into your office, but about the patients that you haven't seen yet and if their physicians, their primary care doctors are unaware of the benefits of chiropractic care. In my opinion, again, the onus is on us to get out there to build those relationships, to bridge those gaps, and to do it through research. So if you'd like to learn more about this piece of research or any other piece of research that we've highlighted thus far on the Evidence Based Chiropractor podcast, simply visit theevidencebasedchiropractor.com and in our show notes you'll see all of this information hyperlinks so you can have direct access to this until next week. Have a fantastic week in practice and we will talk to you soon.

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