210- Maintenance Care Research Updates

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Happy Holidays. Merry Christmas. It is that time of year but on this podcast we are not having any lull whatsoever. We are hitting it hard this week with a brand new paper that I know you are gonna wanna hear about. It is titled Chiropractic Chiropractic Maintenance Care. What's new? A systematic review of the literature. This was just put out by chiropractic and manual therapies and it tackles one of the most controversial topics ever in chiropractic, which is maintenance care. So we're gonna break it down and talk about how you can maybe utilize this for your thought processes for your patient care and ultimately just keep you up to date on what's going on in the world of research and marketing. So we're gonna have fun with that. Also, big shout out to the CSA group. Kevin Christie, Bobby Mabie invited me over for their winter retreat in Palm beach, couple hour drive from my house here in Tampa and it was awesome to meet up with a ton of docs who are involved with the smart chiropractor, the evidence based chiropractor. Listen to the podcast off the top of my head. Dr. Todd Sullivan, Dr. Daniel Yin, Dr. Wasserman. Thank you for tuning in. Thank you for saying hi. Thank you for being part of who I am and what I do. I appreciate it. I love getting out there and meeting docs who listen into this podcast. It's awesome. So thank you a ton to Kevin and Bobby and thank you a ton to everybody including you who's listening to this right now. Before we get started, I will say a few words about Rock Tape. Rock Tape has revolutionized the soft tissue world again with new Rock blades, Mohawk. Three tools in one, you know about it and you could pick up the tool and see all of the educational courses@rocktape.com Mohawk they're 175 bucks. Also, if you did not check out my interview with Dr. Steve Capo Bianco who ultimately is the medical director at Rock Tape, you are going to want to do. So Capo breaks down where they are going in 2020 and even previews a movement assessment app that is going to tie the assessment to the treatment that's coming in 2020. Lots of exciting Stuff to hear about from rock tape as they continue to roll through and push the envelope as far as performance and movement. Now let's get down to the research. Chiropractic maintenance care. What's new? A systematic review of the literature. That's what we're talking about. And my question to you listening right now is, do you recommend maintenance care to your patients all the time? Sometimes. Never. The truth might lie in the in between, as usual, Right. In the it depends territory. I'm gonna read the conclusion that these researchers found first, then we'll break it down. They found presently maintenance care can be considered an evidence based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain who report a good outcome from their initial treatments. Wow. All right, so that's a lightning rod. So. So let's break that down. Right. We've discovered throughout the literature over the last 10 to 15 years, low back pain is not something that just comes, you take care of it and you never see it again. Researchers kind of compare it to asthma, meaning there can be episodes of back pain and it can be dormant at times, but it's kind of an underlying chronic condition. So it can be a lifelong challenge. But that doesn't mean it needs to be bothering you all the time. So it's episodic by nature, which is what we've seen in many, many papers. I don't think anybody would disagree with that whatsoever. So then they go on to say, well, let's define what is maintenance care. And they describe maintenance care as a type of prolonged care delivered at regular intervals. Okay, so that's pretty easy, right? We also found for many chiropractors that were surveyed, you know, patients stated that the purpose was to prevent reoccurrences. 80% of people said, hey, I go in to see a chiropractor for maintenance care to prevent reoccurrences of. My issue. Right. Then second to that was to remain pain free. About 70% of people said it's to remain pain free. And only about 20%, a little bit less than 20%, echoed a holistic view that maintenance care was used to prevent disease in general. So that's kind of just taking the pulse, right? What do patients think of maintenance care? About 80% think it's to prevent future episodes of back pain. About 70% say it to remain pain free. About 20% believe that it is about a holistic view of care. So that's just kind of a little bit of a pulse check. Now let's take a Look at the chiropractic side. They found through surveys that a majority of chiropractors stated that they believed in maintenance care and that it could be used as a preventative tool, at least sometimes. Guess what percentage of chiropractors said that. 98%. So an overwhelming majority, nearly everybody, and I would agree with this personally, believes that maintenance care is a good idea as a prevention tool, depending upon the case of the individual. So let's talk about the stats that they showed. They found, thus the mean proportion of patients seen on maintenance care Regimen was around 22 to 41%, with individual variations ranging from 0 to 100%. Some practices said 100% of our patients got on maintenance care. I don't know about that, but. And there's some, chiropractors said 0%. In my opinion, they might be doing their patients some disservice, but most about 25 to 50%, if I'm just ballparking it, of patients in a practice are on some sort of maintenance care system program, however you want to define that. So let's take one step closer, one step closer look at what else these researchers found. They found back pain is a chronic disease for most with episodes at short or long intervals. A preventative approach such as maintenance care, therefore makes sense. So let's talk about this. I actually just last weekend, not having read this study in Palm beach, asked the room of docs, probably about 25 docs, I said, who in here prescribes maintenance care to their patients? And I'd say 75% of the hands went up in the room. I said, how many chiropractors in here, how many of you prescribe wellness care for your patients? Like one hand went up. So there's some amount of semantics involved with that. But the interesting part about it is that maybe the 25% of hands that did not go up when I asked about maintenance care, and I think this is an important topic to break down, there is so many, let's say, evidence, informed chiropractors out there that are doing fantastic work. But there are some within that community that, in my opinion, have swung the pendulum too far the other way. And here's what I mean by that. They've become so disenfranchised with the docs out there that maybe they believe are overselling care and, you know, long treatment plans, big upfront costs, et cetera, that they've swung the pendulum so far back the other way that they're treating patients for two or three visits, saying, hey, get outta here. You don't need me anymore. With absolutely no follow up, no next steps, and no clear direction on how the patient can manage potentially the next episode which is gonna face them down the road. And to me, this is where in the evidence informed, evidence based world, there's almost a divide, meaning, you know, there's certain people that are so what I'll say hardlined that in some cases they're probably doing their patients a dramatic disservice. Whereas being more towards understanding, hey, semantics aside, let's just take a look at this. Back pain is something that's gonna affect nearly everybody. It is episodic by nature, as the researchers say, with short or long intervals. And as we've seen in previous research papers talking about maintenance care, chiropractors are in a very unique position to be able to analyze, to be able to assess movement, to be able to address symptomatology early on and biomechanics, how people are moving, how people are feeling. Right. All of those things are right in line with what a vast, overwhelming majority of us do as chiropractors day in and day out. So taking that quote, unquote, pulse check with your patients at some sort of interval is probably a really good idea. Many of us, especially those who are focused on movement, can look at movement patterns and say, gosh, I'm seeing a dysfunctional movement pattern here, which is going to increase the likelihood of some pain down the road. Right. Pain typically follows dysfunction. So being able to analyze that, stay on top of your patient, so to speak, meaning guide them in the right direction, to me is one of the most critical aspects of what we can do as chiropractors long term for our patients. Yes, we're very good at crisis care. In the absence of red flags, it's pretty darn compelling when you can treat somebody two to three times and have them go from ready to proverbially jump off the cliff to feeling great and ready to refer their friends. We see those type of things each and every day in our practices. Now, the next step of that is understanding. Let me talk with and guide this patient through what they may experience in the future. And this goes hand in hand to what I'll call lifetime retention of a patient. Which doesn't mean three times a week for the rest of your life come into my practice through scare tactics. But what it does mean is the ability to accurately discuss with them the fact that back pain by nature comes and goes throughout time. And there are certain things that we do in our office that many patients choose to engage with that can help or has the potential to help fend off future episodes. And some of that might revolve around X, Y and Z, as X, Y and Z, depending upon who you are and what your practice looks like. But many of us have the tools, have the skill set, but often either through maybe a little bit of fear of having that conversation with a patient, or perhaps we've swung our pendulums so far back the other way in, you know, in disgust of what's going on with a very, very small group of providers that we're actually doing our patients a disservice. So if you're somebody out there that really rarely, if ever recommends any. Any sort of maintenance care or as needed care, if you're somebody out there, you know, that really prides yourself on two visits and get out of my office, you know, in a good way, I'd really recommend, you know, take a look at this study and see how it could potentially apply to you, your practice, and your patient base. And here's another thing to think about regarding it that I think is super, super important. I was discussing this with a few docs this past weekend. You know, we take care of our patients, they're feeling better in a few visits, they're ready to go, and. And they go back to the same exact lifestyle that they had before. You think that that pain is not going to come back when they go back to sitting in the same car in the same long commute, have the same stressors, the same lack of exercise and the same long hours at a desk or standing each and every day? You got to be kidding yourselves. We are a fantastic intervention that is conservative, that's safe, that's effective. However, we are probably in even better guide with our patients. A guide for our patients to experience life in the best manner possible. And that starts with not being bogged down with back pain every two to three months. And it also becomes something where we can coach and guide them regarding exercise and activity. It's something where we can coach and guide them for many of us in the nutritional aspects of how to stay. I mean, this transcends just the adjustment itself, what we can offer. There's so much power in what we do with the manipulation or an adjustment, but there is so much additional education and resources that we have that many times I think we take for granted. So what I'm gonna encourage you to do this last week of the year, enjoy the time with your family, check out this paper and really think about in 2020, how you can further help guide your patients to living a better, higher quality of life with you as their guide throughout their time in your community. So with that, I hope you have a fantastic week in practice and I will talk to you very, very soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.