402- Evidence Based 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. On today's episode we have more research, a brand new study that came out and it is all about evidence based maintenance care. And this is a cross sectional survey, brand new chiropractic and manual therapies. I'll hit on the title in a moment. We'll of course drop the link to it in the show notes down below. But before we get started I want to give a couple shout outs. So these are winners over the last couple weeks. If you've been following along. We hit our 400th episode which is awesome and totally insane. And as a huge thank you, I said anybody who leaves a review, I'll pick out some people to receive some prizes. So I'm going to call out some names. I'm looking at Apple podcast reviews right now doc. If I call your name, shoot me an email because I'll need to get your address and some of these your real full name. So Dan Allah Hit me up via email. Dr. Christina B. Hit me up via email Q33Z hit me up via email. Dr. JScharrell Brandt, D.C. and N. Bossi. If you are one of those six individuals please shoot me an email. I am happy to hook you up. Thank you so much for listening, tuning in and taking time out of your day to leave a review. And if you're listening and you have not left a review I I'll ask you to do so. Helps more and more docs find out about the podcast and I greatly appreciate hearing from everybody. Additionally, if you would like to kick up your reactivations hitting heading into the fourth quarter of this year, schedule a demo the smart chiropractor.com our automated system we're launching next week. An upgrade that actually gives you a reactivation report each and every day. For the people who have clicked, called a schedule and clicked a schedule in your email, serving them up on a silver platter making it super easy. You can head over check out a demo of Patient Pilot pilot@the smartchiropractor.com but as I said at the top of today's episode we're talking research. Brand new study that just came out hot off the press in chiropractic and manual therapies and it is titled Evidence Based Maintenance Care among chiropractors in Norway, a cross sectional survey in the Nordic Maintenance Care Program. Lots of great clinical pearls. Let's dive right in. The researchers highlight that chiropractors do use maintenance care secondarily and tertiary as a prevention strategy to, in ideal world, manage recurrent or persistent musculoskeletal pain. And I am. I'll plant my flag right here early in this episode. I am a massive fan of maintenance care. I will go so far to say if maintenance care is not recommended to your patients, you are doing them a disservice. Why? Because we know gravity is eternal. The people will be under load. We also know that people will continue to age. And with gravity and aging, there is no question that ensuring people are moving, whether you're doing movement assessments, sfma, DNS, however you're assessing people, it is important to have an assessment. And as my colleague and old instructor, Dr. Dave Seaman used to say, it's never a bad idea to get a crunch every once in a while. And I could not agree more. So I am a big fan of maintenance care because I believe it's not only managing, but it also has the opportunity to prevent. And as healthcare providers, getting somebody out of our practice in two visits because they had a dramatic reduction in their pain is a really bad strategy for a lot of different reasons. Now, the patient might opt to leave, that's okay. But if that's the recommendation, you're doing them a disservice. Why? Because they're going out and going under gravity, they're going under load, they're continuing to age. And two visits, three visits, four visits, five visits, you're not even remotely close to touching. Behavioral change. And that's some of the most important aspect. Pain is the last thing to come and the first thing to go. But behavior change, movement pattern change takes time. It takes training, it takes assessment, it takes feedback. And that can only happen through time it takes to get there. So that is an important component here. So they define maintenance care as treatment that continues after optimum benefit is reached, regardless of the symptoms. Great way to put it. Couldn't agree more. They also say maintenance care can be used to reduce the impact of recurrent pain and minimize consequences of either chronic pain or episodic pain. Absolutely true. So here is the gist of it. And this is kind of what the research cites. There's a little bit of a wide berth, but patients with recurrent or persistent low back pain who do respond well initially and have a what they refer to as dysfunctional psychological Profile meaning high pain severity which interferes with daily life, high stress, low perception of life control, low activity levels. Those are people that tend to respond the best to maintenance care. Why? Well, the best predictor of tomorrow's weather is today's weather. So when you have somebody who has responded initially very well, that's a good indication that they'll respond well in the future. And additionally, those individuals who have, as they refer to here, a dysfunctional psychological profile, those are people who also respond very well. Why? Because you're helping them overcome the fear of movement, in my opinion. So that is a really important component. So there were a few items that they were trying to explore in this study. There were six kind of big questions, seven big questions, I should say, and I'll list those off quickly and then we'll kind of wrap with some of the findings. So they were trying to explore what are chiropractors attitudes towards the usefulness of prescribing maintenance care? Do chiropractors number two, do chiropractors think they have the skills to identify patients who are likely to respond either positively or negatively to maintenance care? Three, do chiropractors use published information to identify patients suitable for maintenance care? I'll kind of come back to that one in a little bit. Four, do chiropractors consider that barriers exist regarding access to useful resources? Five, do chiropractors believe it is a facilitator to have knowledge of which patients are likely to respond positively or negatively to maintenance care? Six, what are the associations between the attitudes, skills and use of evidence based practice in the use of maintenance care? And seven, what are the associations between attitude, skills and use relating to maintenance care and other chiropractor demographic pieces of information? So this was sent out to about 800 docs in Norway and they had a 41% response rate, which isn't bad at all. Most of the docs, 70% were between the ages of 30 and 50 and about half, 55% technically, had been in practice more than 11 years. So good amount of experience, which is awesome. Most of the chiropractors had graduated from a chiropractic school in Great Britain, 62% and many held a bachelor's or higher level degree. 66% and 68%. This is super interesting and totally different. Compared to the United States, 68% worked in a clinical setting with conventional healthcare providers. Only 8% were in solo practice. I think it's like in the United States, like 77% of chiropractors practice in a solo practice or Some astronomical figure. So it's literally the reverse. So it's interesting to point out in relation to how we go through the findings or the results. Keeping in mind nearly 70% of these people were working of these docs were working in a true multidisciplinary, conventional healthcare practice type setting, which definitely can, in my opinion, skew how they go about patient care. It's just a totally different treatment flow. So I'll go off on a little bit of an aside. This is not what they say in the study, but usually when somebody's in solo practice, and again, Norway might be a little different than the United States in this case. But I just want to highlight why I said what I just said. If you're in solo practice, you're eating what you kill. You have to go out there, build your name, get patients to come in. It is whatever you bring into the practice is what you're seeing. High, low, indifferent. And your ability to communicate who you are and what you do is, is 100% directly proportional to the success you'll have in practice. However, if you're in a multidisciplinary practice. I practiced in two different orthopedic groups. It was a totally different patient acquisition process. People would come in through urgent cares, people would come in through the primary care providers, through the, through the surgeons. However, if they're the pain management specialist, they'd come in that way and then most of the time they'd make their way around to chiropractic. So it was a really different acquisition process that was a lot less direct to consumer. In my experience, when you were in a multidisciplinary setting versus being in a solo practice. So they found in this. So this. Now let's get into some of the discussion and I think it sets the stage for this. They found that most chiropractors had neutral attitudes towards maintenance care, which absolutely blow my mind. But that's based upon what I said earlier. They felt confident in their skills and, and they felt confident in their ability to find patients that were suitable. How only a small number of these chiropractors reported reading research on maintenance care in the previous month. That's an interesting aspect to the study. I don't mean to criticize the researchers, but you know, reading specifically a maintenance care journal over the last 30 days seems like a far fetched ask. It's like if they read one paper, a practicing doc reading one paper a month seems like a lot to me. And quite frankly, if we extend that beyond, we should be better than what I'm about to say, but if we extend that beyond, you know, do we think that the medical doctors are reading papers, well, clearly not about neuromusculoskeletal care or else they wouldn't be making the decisions that they are because they're completely contrary to all evidence for the last 15 years. But they highlighted in this study, I don't take that as a negative. I read it as if it was sort of a criticism. It might not, I might just be reading it that way, but I don't think it is to not have read a paper about maintenance care in the last 30 days. Sometimes I might go 30 days and I read papers as part of my living. So important consideration. Chiropractors perceptions also towards evidence based practice were generally good, but they were mainly neutral in their attitudes again towards maintenance care, which I feel like some of that probably is due to set and setting of their practice. Although that is a guess, I don't know that for sure. So chiropractors working in an environment with conventional healthcare providers rated their maintenance care skills as low. So it also might be a skill level based on their set and setting which would make sense to a certain degree. And chiropractors practicing in solo practice, educated in the US and Australia were confident regarding their maintenance care skills. So totally different. Interesting demographic information. And those educated in Australia had high confidence in maintenance care skills but only amounted to about 9% of the sample size. So it was a minority of the docs that had replied to the survey. So the conclusion here was quote the Norwegian chiropractors generally had neutral attitudes towards the available the tools available to utilize the evidence of maintenance care. They reported moderate skills and most had not used evidence about maintenance care the previous month. Access to useful resources about evidence of maintenance care was a barrier for most chiropractors, although most thought that knowledge of responses to maintenance care were a facilitator so long winded way of saying I think that we have a long way to go in terms of helping everybody that is a chiropractor first understand the benefits of maintenance care and how to best select the most appropriate people. Now clearly if somebody it's not a great candidate for maintenance care if you are unable to achieve any benefit with the care that you're giving and benefit. Let me be clear. I don't just mean pain reduction, I mean functional benefits, increased range of motion, ability to have better quality life. If you're hitting none of those with somebody, then that person's probably not a good candidate for maintenance care because clearly you haven't taken care of the primary issues of what they came in with. But don't be so myopic to believe that benefit is pain related. Pain is a part of that, but we're talking about again, pain, functional movement, quality of life, activities of daily living. You might still have some pain, but be able to function, have better range of motion, do the things you want to do, and quite frankly, sometimes those are the things that cause pain. And so you, the pain might stick around, but you're able to do those things and maintain maintenance care. Here we go. Tie in. Maintain your ability to live a high quality of life despite the pain that you are in, and the fact that the pain might be steady but not getting worse, but you're able to do what you want to do anyway. With that being said, I think it's important for all of us to take stock of how we are approaching maintenance care in our practice, how we're communicating maintenance care to the people that are coming into our practice so that we can be the most effective chiropractors possible. And this study highlighted, at least in the Norwegian population, that it's sort of muddling, it's middling. In other words, chiropractors. Yeah, the skills are okay, they don't feel like they have that better great of knowledge to make the decision, et cetera, et cetera. So hopefully an episode like this points you as a listener in the right direction. And if you need more information, then I'd encourage you head over to PubMed search things. I have released probably no less than a dozen podcast episodes about maintenance care in the past because there's been a really, a lot of really fantastic research regarding it. So if you feel like you need to bone up on your skills and the research regarding maintenance care, just search this podcast. There's literally probably 12 plus episodes that dedicated to the benefits of maintenance care. I think actually episode number one of all, episode number one of this podcast 402 episodes ago, May have been relative to maintenance care. That might not be the one you want to start with because I can assure you the first 10 episodes, oh my goodness, if you want to go to sleep, I think you should listen to the first 10 episodes of this podcast. But as with all skills, things improve over time and I appreciate you for following me on that journey as hopefully my skills have begun and continue to improve. So if you'd like to improve your skills on maintenance care, be sure to get the information necessary to do so. And I'm going to ask you as a chiropractor speaking to a chiropractor. Please be sure you're proactively having these conversations with patients in your practice. Ensure that you are offering the opportunity for them to continue when appropriate. It is absolutely critical and not in just a way of well, you could come in. That's just not. You have to give some oomph. It doesn't mean you need to be disingenuous. You should actually be completely truthful and ethical for the fact of. Hey John, you've had fantastic results so far with the care you've received. As a matter of fact, today when you came in I noticed you said you had no pain at all. Now I want you to know pain is the last thing to come on. It's the first thing to go. So just because you've gotten out of pain, we, that doesn't mean you're through. Let's take a look at your movement patterns, let's assess and I'm going to ask you some questions to see if any of your behaviors have changed so that you, you can ensure we reduce the risk of any of these challenges coming back in the future. As a matter of fact, the best patients that receive ultimately the best results in our practice tend to come in on a maintenance basis because just like you, they want to go out and swing the golf clubs, they want to live a high quality of life and they get older. I hate to tell you John, all of us are going to get older, all of us are going to be under gravity. And I know you want to stay as active as possible and you can, but you have to do the things necessary maintenance wise and proactively to ensure that you don't get into the situation you were a few weeks ago when you first came in. My best recommendation is X amount of times over. X amount, whatever that might be. So that's an example of how I would approach it in practice. You can take that and align it with how you approach your practice. But ultimately, great study. A lot of take home messages. You can check it out with a link down in the show notes. And additionally we are heading into the fourth quarter. Before we wrap up, I want to say a few words about chiro matchmakers. If you are looking to add on a Virtual Chiropractic Assistant, 70% reduction in a actual in office cost. Really great way to do your outbound phone calls to do a lot of these tasks. So if you're looking for a virtual chiropractic assistant, an in office chiropractic assistant or an associate DC literally now is the time to have that conversation and see what the process looks like for you. Why do I say that? Because right now you can hire somebody as quickly as possible and have them trained up so you meet and exceed your fourth quarter goals. I can tell you in about another eight weeks all the pipes get clogged. In other words, it becomes dramatically more challenging to find talent as you head into the holidays and now you start looking towards the beginning of next year. So instead of waiting to next year, by the time you have somebody coached and trained up and then being productive in your practice, get on it right now. And if you're interested, head over to ChiroMatchmakers.com, schedule a complimentary call with the team and discover what and how we can help you. I hope you have a fantastic week in practice. Thank you for being a chiropractor and I will talk to you soon.

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Sam.