028- Differences in Chiropractic Patients and Medical Patients

Welcome to the Evidence Based Chiropractor providing you with elegant and efficient research based content to help your practice prosper and succeed. Now get ready for a variety of dynamic communication tools designed for immediate growth. Courtesy of your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today our episode is on location. I am currently sitting in a hotel room in Oklahoma City, Oklahoma. I'm out here for some continuing education so this is going to be a little bit different than we normally do week to week. Today I actually had the opportunity to sit in a class taught by TJ Williams and he taught a clinical nutrition class that was absolutely fantastic. I actually am going to be reaching out to him and I hope he can be a guest on our podcast in an upcoming episode. But today we are going to talk about low back pain in a primary care setting and it was a description of 1250 patients with low back pain in a Danish general and chiropractic practice. This was published by International Journal of family medicine in 2014 and it's a really interesting take or insight into chiropractic patients versus general practice patients and we will dive in momentarily. Before we do, I'll say a few words as I do each and every week about Rock Tape Rock Tape is proud to be a sponsor of the evidence based chiropractor. Rock Tape 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. They are more than a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com also I've been teasing it but this coming week I will have an interview scheduled with Dr. Capo at Rock Tape to talk about Rock Blades. The product is awesome. I know they're having their summit out there currently at Rock Tape headquarters. I wish I could be there, but I was happy with the information I certainly got from Dr. Williams today here in Oklahoma City. So without further ado, let's dive into this week's research. Low Back Pain in Primary Care. A description of 1250 patients with low back pain in Danish general and chiropractic practice. And again, this was published in the International Journal of family medicine in 2014. So one of the greatest challenges we all know for primary care physicians is determining the best plan of care for patients with spine complaints. This is why they refer out so often or rely on medications in their own practices. In this study, nearly 80% of patients had previous episodes of low back pain. These are patients that have recurrent low back pain and a vast majority of these patients will not require surgical intervention. Conservative pharmacological treatment often doesn't produce the best long term outcome. If you've been listening to our podcast week in and week out, you know that the research does not substantiate pharmacology in terms of the best efficacy for the resultant good outcome in low back pain care. Coordinated case management between primary care provider and chiropractor is paramount to achieving the best results possible. Of course, that's why you're listening as somebody who's interested in the evidence based chiropractor. The efficacy and safety of chiropractic care has been well documented. We go through it each and every week. Reducing the disability and achieving MMI are important goals in any typical plan of care. But providing the best evidence based case management and providing patients with the tools and resources necessary to avoid future episodes is really what sets chiropractic apart. So there can be a variety of modalities that really reduce disability and there might be some functional gains, but I think the really the difference what sets chiropractic care apart is ultimately not only the evidence behind it, but but ultimately really the prevention of future episodes of pain. And we've gone through that with that landmark study from Spine Journal which really supported maintenance care for the reduction of future episodes of low back pain. And in this study, as we touched on at the top, every patient was a recurrent back pain patient. So let's talk about a few of the findings that the researchers found in this study. 1, 1 they found our results show that low back pain is not negligible in primary health care and support previous studies suggesting that low back pain should not be seen as benign or self limiting. So ultimately, the researchers are stating with this statement, they're emphasizing the fact that low back pain can be debilitating, that it's not negligible, it's not something that should just be considered benign or self limiting, but it's something that can truly reduce function. And when function is reduced and mobility is reduced, as we talked about a few weeks back, that can limit the ability for people or patients to be independent. As independence goes down, a lot of other health care challenges set in. So it's an important statement to start off with. Second, they found, judging from the scores on the Roland Morris Disability Questionnaire. The low back pain considerably limits daily activities. And almost one third of the patients in general practice were in the group with a high risk of chronicity according to the Start Back screening tool. So when they looked at a screening tool that emphasized or looked at the potential chronic nature of low back pain, nearly one third of the patients in this study seemed as though they might be headed that way. And once pain becomes chronic, it's much more difficult to overcome than an acute episode. Of course, they also found a strong and focused effort should be implemented in primary health care to reduce chronicity and disability. Goes without saying, but important, I think, from a research perspective to put out there. And finally, they found this makes the need for good and evidence based treatment early in the course even more evident. And this has to be initiated in primary care. So this really further emphasizes the fact that the earlier you catch things and the earlier treatment begins, the better the outcomes will be. So I'm going to kind of piece together a few items on a chart here, so it might be a little bit difficult to follow on the audio, but I think you'll certainly get the point. When they looked at the duration of episode of chiropractic patients and general practice patients, less than two weeks, was nearly 70% of the chiropractic patients, only about 35% of the general practice patients. If we jump up the other direction, the duration of the episode with chiropractic patients, by and large was about one third of the duration, maybe eight to 10 weeks. And the duration of the episodes with a general practice patient nearly reached 35 weeks. So this shows us that the chiropractic patients, ultimately their duration of episode, whether on the short end or even on the longer end, were far less than the general practice patients. Also, when they looked at previous episodes, zero episodes previously, it was about the same between the chiropractic patients and the general practice patients. But by the time you got up to more than three previous episodes, the chiropractic patients had, there were less chiropractic patients, should I say, that had more than three previous episodes than general practice patients. So to me, that starts to emphasize the point that chiropractic, again, this is not the point of the study, but I think it gets to a very interesting thing when you start to look at the breadth and depth of this, the research out there that chiropractic patients are perhaps prone to have less episodes of low back pain over the course of their lifetime. And that's extremely important when you can again reduce disability, increase function, and certainly decrease pain. People are going to be more active and they're going to have a significantly higher quality of life. And that, as you know from me, that is what we are all about at the Evidence Based Chiropractor, highlighting chiropractic research week in and week out that emphasizes what we do as chiropractors and really puts it into an actionable place that you can speak to your patients and other care providers about this. So this research study that we it was from the International Journal of family medicine in 2014. Again, we highlighted this as our bonus brief for all of our members for a holiday in 2014. So we highlighted this just months after it was released to the general public. Hopefully, I think you get a few good tidbits here today where you can dive in and perhaps use some of this in practice as well. So in closing, I'd like to say a few things. If you've been listening to the Evidence Based Chiropractor podcast and you have not left feedback or review or any sort of stars on itunes, I would encourage you to do so. When you do that, it really helps boost us up and get us out to even more chiropractors out there across the world. So if you have the opportunity to give us some feedback or rank the podcast, I would greatly appreciate it. Number two is that keep on the lookout in your Chiropractic Economics magazine. I am very, very grateful that I've had a column produced and there was another one on the way that I just received in my mailbox last week from an upcoming issue of Chiropractic Economics. So please keep your eye out from that. If you have the opportunity to see that, whether it's in print or on Facebook, if you can share it with your friends, if you feel like there's value there, I would greatly appreciate that. Third, as time goes on, the Evidence Based Chiropractor is going to continue to evolve with the practice of chiropractic. We have a few great upcoming expansions on our plate while continuing to serve you on a weekly basis through the podcast, on a daily basis through our Facebook page, and certainly for our members through that monthly research brief which is the heart of what we do. If you are not yet a member, I don't know what you're doing, but please check out the evidencebasedchiropractor.com and see if we can help you grow and build your practice. If you are a member, you should have received an email and I've reached out to just about everybody, but please, we just started a Facebook group for members. It is a mastermind group on Facebook where the members of the Evidence Based Chiropractor can strategize, share items, share information and really take their practice to the next level. So I am very excited about that. I want all the members to be involved in it. So please go on Facebook, search the Evidence Based Chiropractor Mastermind Group. If you are a member and you are not already a part of it, please, we'd love to have you involved. It's how the group expands, it's how the knowledge is shared and it's ultimately how we raise up and better ourselves as practitioners and ultimately as a profession. So I hope you have a great week in practice Doc. I am looking forward to getting back to my family tomorrow night back in Tampa, Florida. This has been again recorded on location in Oklahoma City, Oklahoma. So I hope you have a great week in practice and we will talk to you soon.

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Sam.