392- The Importance of Functional Assessment Tools

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. On today's episode, I have an awesome interview that is all about functional and objective assessment tools in a chiropractic practice. I had the opportunity to sit down and chat with Chris Neal, CEO founder over at jtech Medical around all things range of motion, grip strength testing and more. This is an action packed episode with a lot of clinical pearls. Take home messages that you can utilize and should be utilizing in your practice each and every day. So, without further ado, here's my interview with Chris Neal of jtech Medical. Chris, thanks for coming on and chatting today.

Hey Jeff, it's good to be with you.

It is my pleasure. You and I have had a lot of discussion over the last few months around this topic and it's one of the reasons why I wanted to ensure that we talk about it on the podcast and through videos. So many chiropractors out there that I know are looking for functional assessment tools, but many of them think spine only. I want to peel back the onion here a little bit and first let's set the stage. What is a functional status assessment tool?

Well, in its simplest form, Jeff, it's really a way of quantifying injuries and normally that's around range of motion and muscle strength and taking those two factors from any part of the body and putting them together to create that assessment.

That makes a lot of sense. Now, when we apply that to an injury, specifically range of motion and muscle strength testing, I see that a lot in the literature that we highlight each and every week on this podcast. We see a lot of times within, within the literature, there are assessment tools such as range of motion and strength. Why are range of motion and strength so critical to be used as assessment tools? What's the foundational components there are?

Well, I guess it comes back to the AME guides for quantifying impairments. And that really is the bedrock of all of the ongoing research. And often when you see these papers, they're following the methodology that's set out there or at least intentionally there. And we actually supply equipment to a lot of these research groups and universities and stuff. We've got a lot of long standing partnerships to provide equipment that goes into these trials as well. So we often get a nice insight into what they're measuring and what the goals of the study and things are. Yeah, yeah.

You and your team have shared a couple of really great studies that I think we've actually highlighted on previous episodes here. So I greatly appreciate that. Strength testing, I think of this. So, you know, I'm dying to dive into how you have really brought strength testing to the 21st century with a lot of the technology that you brought out. I remember like back in the day, we're like strength testing and shaking somebody's hand. That's about three out of five, you know, and, and, and the tools today are so wildly different. They're so much more objective, they're so much more complete, they're so much more data driven. Let's dive into strength testing, which I know goes beyond just the handshake itself, but when you look at the tools provided by jtech to chiropractors and other healthcare professionals around the world today, what are some of the. I just love to dig deeper on how do you consider strength testing? What are the gold standards? How does technology weave its way throughout it?

Yeah, so for us, when we're looking at strength testing, it's really been able to quantify it in a quick and easy way for the physicians so that they can get the data to really help a patient understand the severity of the injury. And then as they're going through treatment, they can show them how the treatment is benefiting them. For us, there's, there's a couple of components to that. I mean, those sort of manual tests that you describe, I mean, they're fine. That's how you open the door to the requirement for more deeper analysis. And for us that's really about the maximum strength and then the sustained strength over different times. So, you know, grip strength is one that most people can relate to. And there's the maximum grip strength, but then there's also the how long can you sustain that grip strength for? And in kind of technical terms, that's the force over time. And our software is good at capturing all of that data in real time using wireless devices and it displays it automatically so that both the doctor and the patient can kind of see what they're telling them. And it really helps you sort of dial into specific regions or areas of the body and quantify, let's see, the root cause injury and then maybe other secondary conditions that are around there. So that's normally the main benefit from more in depth muscle strength testing.

Yeah, being able to compare you. You brought up a great point there. And that's Also not only the initial test, but being able to monitor that throughout. And, and that's where a lot of what I'll refer to as the old fashioned methods fall to split. I don't know, it's about three out of five. It's been a two months. You retest somebody having the objective data and the specificity that a modern tool can bring to the table really allows you to track progress at a level far greater than just through what I'm going to call manual subjective testing alone. And that in and itself is a really important component for why these tools are so necessary in a modern practice. I'd love for you to highlight range of motion. You just did a great job breaking down the importance and benefits of strength testing as well as the technology components. When we think about range of motion, I'll go the same direction. I remember being trained in school and it was like turn left, turn right and you're kind of eyeballing it, so to speak. What are the range of motion? What does a modern range of motion tool look like, feel like, what kind of data does it collect? What are the importance of really the specificity?

Yeah, again, it's wireless devices. We use a dual inclinometry system, so that gives you the highest accuracy and we follow the anatomical locations set out in the AMA guides. So again, all of our system is taking the foundational training that the doctors have and just looking to automate it and make it easier for them. When we look at range of motion testing, we can do spine and we can do extremities, we can go all the way to digits and toes if required. And again, you're able to capture a lot more meaningful data in a lot shorter time frame. And of course it's got that objectivity. It's coming directly from the devices. It's highly repeatable results and that can be important for, for let's say the people who are either involved in the treatment or maybe responsible for reimbursing some of that treatment. In terms of the results themselves, the software automatically gathers those range of motion statistics. It will compare it to any previous measurements you've done and it'll also compare it to the normative values that are set out by the AMA as well. So for your demographic, we'll be able to see where you stand against, let's say an average in the population. And we can also compare bilaterally. So if you've got a deficit in one side, you can show the patient quite easily compared to the other side what that difference is. And then how A treatment plan will address that difference.

Yeah, that makes me think of, you know, one fact is a statistic and two, as a story and being able to tell the story of what that person is going through by understanding and by having the technology through jtech Medical enable you to compare to what's the normative range, what's the average? Where should this person be? Where have they been in the past? Where are they at today? That provides a tremendous amount of benefit from a clinical sense, but also I think about it from a patient communication sense. The more specific that I can be as a provider, helping somebody understand the benefits of the care that they've received or the challenges and the plateaus that they've encountered, the more proactive you can be with those conversations, the better off you are going to be. The better off you're going to be able to guide that patient and set the right expectations so that you can hopefully meet and exceed those expectations. Which I say the side effects of that are more referrals, more reviews, more testimonials, because the patient really has a clear understanding and utilizing functional tools and specifically with modern technology such as jtech, what you guys bring to the table so important because it makes it easier to be able to have an accurate conversation. When you can have an accurate conversation with a patient now, you start to be able to guide their thinking, you guide their process so that you're setting the expectation, hopefully meeting and exceeding the expectation, and they can feel great about the care that they're receiving and understand where they're going next. And a lot of that also makes me think towards the Metalegal system. And having the data is, in my opinion, critically important and imperative for any type of patient that you're seeing. However, when we move over towards work, comp, personal injury, things of that nature, it becomes not necessarily a nice to have, but an absolute need to have. Talk a little bit about how you've seen functional testing intertwined, so to speak, with the med legal system. What are some things out there that listeners need to be aware of regarding this?

Yeah, a lot of our customers are really concerned about the integrity of the data that they're capturing. So often, if they're ever challenged on these results, the challenges will come around. How was the data captured? How was the equipment calibrated? How do you know this was reputable equipment? Of course not. Eyeballing and then being able to show, let's see, the changes in progress over time. Like you say, often treatment plans aren't linear, or maybe pain is the primary kind of symptom and then once you get some respite on the pain, it's about following that treatment plan all the way through so that you don't get injury reoccurrence. So the first thing is around that data integrity and obviously our systems are made, they're made here in the usa. We've got the ISO International standard for medical device production. We've complied to that for over 15 years now and we've got over 30,000 customers around the world. So we're quite confident in the equipment and in terms of the calibrations and the accuracy. Our system's kind of self calibrating and it logs all that in the software. So when it comes to that data integrity, you know, that's the first thing that people really look for and then the second thing is how that data is then analyzed. It's how is it presented in the software, how easily can it be communicated to maybe attorneys that are part of the process or maybe insurance payers and making sure that the integrity of that data is strong and then the way that it's presented helps make it irrefutable as well. So we're always optimizing the software and the integration between the devices and the software to ensure that accuracy is there. And that's nice and straightforward in terms of the graphical outputs that's there to be able to communicate the injury and of course the progress.

Yeah. One thing that I noticed checking out the website, I'm going to encourage docs listening and watching. Click on down below and connect with Chris and his team. Specifically, if you are not using what I'm going to call objective functional assessment tools, you need to get on it even if you're using some tools out there. Jtech second to none. So connect with his and his team. I say this also because I'm looking at the website right now, Chris, and one of the things I notice is the reporting, which is a really important component. Having the data is one thing, being able to communicate and share the data is another. Talk about how you think about reporting and the importance of it within functional testing.

Yeah, for us the documentation, that's the ultimate output. So you know, invariably that's the focus. And you know, what we've tried to do within our software is make it as easy as possible for the doctors. And the way we do that is that our reports are generated in under 30 seconds and there's no intervention from the doctor. Right. Whatever tests you performed, whatever protocol you set up, whatever prior measurements you've taken on that patient you're automatically pulled through into this configured report, which you can of course make any edits or observations to. But ultimately our goal is that you finish the assessment and in one click that report's generated and it should be the way you want it to go to the client, the attorney, the reimbursing party. Then we can set up different configurations. So if you have one attorney delays information one way or you have a certain way that you find resonates with your patients better or for certain injuries, then we can set up all these sub templates and the report will automatically populate for you. And we often have people remarking that that's what they like the most because they don't have to spend all those hours after the event doing all the math and then writing up the report or invariably finding something from within the test that was lurking in the data. Whether that's things like coefficient of variation, which is important when you're complying to the AMA guides. If you find an anomaly in there and then you have to call the patient back and redo some or part of the assessment. Whereas again, because our software is kind of doing all that data analysis live, you can see any of those anomalies and catch them and adjust them in real time and then generate that report as well. So I mean, our job really there is to make it really simple and really efficient.

Yeah, that's, that's really impactful. There's a couple things there I want to unpack for everybody listening and watching and make sure that they caught on to. Is one the customization of the reporting critically important? I know in my practices we work with attorneys and golly, if every one of them doesn't want something different and something else. So being able to customize that reporting really streamlines your workflow. And this ties into the second thing. When you can deliver to that third party what they are looking for, it makes their job easier. And you know, I know you know, this is, I'm going to move into business management here. But you tend to get a better relationship and more referrals coming in when you're able to deliver what the other party specifically in a med legal case, is looking for and you make their life and their job easier. And the beauty of that with, with jtech tools is you're providing objective functional assessments. So this is really bulletproof, ironclad data measured, as you've said, against the norms, against the guideline standards, that is really, really impactful and critical. And it can be a big differentiator in terms of how you're showing up to the table as opposed to some of the other practices that they've worked with in the past. And I think that that's a really important component for everybody to understand. Again, this is great for every patient that walks in. They all should have access to the best care and treatment. But man, when you are sweating under the lights of a deposition and wishing you the objective measurements to begin with, JTAC can solve that issue for you hands down. I also look at the website and you guys have an array of fantastic products. I'd love to just offhand, what are some of the top couple products and measurement tools that chiropractors utilize around the world? What are some of the big impact items?

Yeah, normally we see with chiropractors, their favorite tools are the dual inclinometry because that can really help quantify the spine range of motion, but also the extremities as well. Right. Being able to do shoulder measurements and different lower body measurements, that can really be helpful for them. And then that's very often paired with the muscle tester as well. Now this would be the handheld muscle tester for measuring, I guess, different functional muscles. And that's really popular because that can often be used in conjunction with the range of motion measurement to give you that dual indication of where the root of the injury lies. And then, of course, the progress being made. So that package is the most popular. It's really simple to get going with. It builds upon the existing knowledge of the chiropractors in terms of what they want to understand about their patients. And the results of those two tests are, are normally pretty good for patients to get a sense of. They understand what you're showing them. It makes sense to them. You can show deficits one side against the other. They can measure that deficit, you know, through the treatment and show that progress. So those are definitely the most too popular. If the chiropractors are doing a lot of injury cases, we normally see them add on the grip strength test as well, because there's some really key information that can be gained there. We talked earlier about, yes, maximum grip strength, but then there's sustained grip strength as well, which can be a really important factor. And there's also different tests you can do utilizing a digital grip gauge where you can assess things like reliability of effort, and they can help the grip strength measurements can also form part of the whole body impairment rating, which not to go too deep into all that, but the software can capture all, all of those factors and help you calculate that impairment rating. As well. So I would say if chiropractors are doing a lot of injury cases, then typically they would use the grip strength on top of the range of motion and the general muscle testing.

Yeah, that makes a lot of sense to me. The other thing that comes to mind as you describe this is I think about so many docs listening and watching. So many are involved in the personal injury space. They're looking for that clinical advantage. The services and products that you guys provide absolutely will solve that. So I'm going to encourage everybody certainly in the PI realm, this is a must have in your practice. Also thank so many of the younger docs listening that are sports performance related to a varying degree. And yeah, I'm going to say even sometimes in the absence of abject injury, being able to measure biomechanically what's going on functionally, what's going on is a really great way to have progress with somebody when there's functional improvement even if they don't have an, you know, an abject injury. But really being able to utilize the standards and the norms and I even think towards, you know, our friends at TPI and on Base U and really the biomechanics of how a body moves and being able to understand that with real specificity can be a really impactful point. I guess I'll throw it out to you. We're going to be up against the clock here in a moment. But have you seen that, has that been your experience? Have you seen some of the more sports related doctors begin to use this more? I'm going to say from, from a performance aspect even more so than a pain aspect?

Yeah, absolutely. So we've supplied a lot of the major teams in all of the different sports leagues here in the US and internationally as well. And a lot of what they're doing is their baseline and their players and then measuring them throughout the season. And we've, we've had, you know, a lot of feedback about how they've been able to keep people at their optimum condition or they've been able to rest players maybe against what the player wants. But you know, they thoroughly believe that that's helped reduce their, their season end and injury statistics. So we've got a lot of firsthand feedback about where people are really using it for that optimization that you speak of in terms of sports performance prehab, things like that. So yeah, we do have a lot of, of high end clinics that are serving, I mean whether it's professional athletes or college athletes and things like that. Again, it's it seems to be really helpful for them to really, you know, work with the players if they have a complaint and get it really down to the root cause of, of where it's coming from. And then of course doing some conditioning work to, to strengthen that up and make sure they're, they're in the best condition they can be.

There you have it. I'm going to encourage everybody listening and watching. Connect with Chris and his team. If you are not currently utilizing functional assessment tools in your practice, you need to do it whether you are focused on personal injury, whether you are focused on family health, whether you are focused on sports injury and or sports performance. We did a brief overview of how the JTAC functional assessment tools can play a big role in your ability not only to collect data quickly, but have fantastic data sets that allow you to communicate better, that allow you to deliver better clinical care, and that allow you to have more certainty over the care that you're delivering. Chris, thank you so much for coming on and chatting today. Again, everybody listening, click on down below. Connect with Chris and his team to see how you can bring jtech tools into your practice. Chris, thanks for coming on. I hope you have an awesome day.

Yeah, you too. Thanks Jeff.

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