476- Five Key Factors Influencing Spinal Adjustment Success

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 are back with more brand new research and this is a great one. It is all about the factors that contribute to the perceived treatment effect of spinal manipulative therapy in a chiropractic practice. So these are all going to be areas that you can and should lean into in your practice so that your patients have the best experience possible and also get the best clinical results possible. Before we dive in, I'll say a few words about Neck Care, the best objective assessment tool for the cervical spine on the market. The hardware and software is awesome. Reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. You can check it all out@neckcare.com but as I said at the top, today we are talking research and we are discussing the factors that contribute to the perceived treatment effect of a spinal adjustment. This came out in chiropractic and manual therapies in 2024. As you can expect. I will drop a link down in the show notes if you would like to check it out. And this is a good one because how a patient perceives what's going to happen, there's a tie in here. So to placebo. Not that what we do is placebo, but I don't view that as a bad word in any way, shape or form. Placebo is important. It ties into the belief that somebody is on the right track and you as a provider are directly causative to that and things that you do, things that you say. All of the factors we discussed today and more really do affect the the clinical results beyond the physical care that you deliver in your practice. So the objective of this study was to explore the variety of factors during a doctor and patient encounter that could contribute to the perceived treatment effect of a spinal adjustment in a chiropractic practice. The significance of this, of course, is that spinal pain and spine pain, low back pain, neck pain is the leading cause of disability all around the world. People spend a ton of money. It's one of the most expensive healthcare treatment challenges out there, especially in the United States. And also that spinal adjustments are universally recognized at this point as one of the top, if not the top conservative effective option for managing spinal pain and Then we can go into performance, et cetera. So this was a qualitative study and, and it had basically semi structured interviews with patients and the supervising clinicians at the chiropractic clinic. Now this was in a teaching clinic, so they also had some interns there as well. So there were a couple themes that they identified. If we kind of dive right in here, and that's treatment outcomes, what they call therapeutic alliance, as well as adjunctive therapies and then psychomotor skills, significance of cavitation. We're gonna dive into each one of those and each one is really important for again you to understand. And you can say, hey, that's not something that's applicable to my practice, no problem. But I guarantee you there will be at least one or two of these items that is directly applicable in your practice. And the more you understand the factors that can impact outcome, the more you can set up your internal operations, process, procedure and conversations to maximize those outcomes for the benefit of your practice. And number one, the benefit of the patient coming in. So key themes identify treatment outcomes, subjective improvements and objective measures. Again, subjective improvements and objective measures. The subjective improvements were when patients emphasizing symptom relief and a reduced pain immediately. And one of the direct quotes was obviously I left with less pain than I came in with from one of the patients. So we know this, we've moved far beyond just pain relief when we apply our craft. But pain relief, if somebody's coming in for that, their ability to feel well fast is really impactful to them and it's important not to forget that. So emphasizing the symptom relief and it doesn't, oh, I'm gonna stress this time and time again, it doesn't need to be an 8 out of 10 to a 2 out of 10 on the first visit. That's sometimes going to happen, but many times not just chipping away, do they have a slight amount of relief that shows that you're on the right track. So those subjective improvements, objective measures highlighting measurable improvements such as range of motion, et cetera, this is for all you DNS, sfma, rehab based stocks out there, objective measures matter are you, but they only matter if the patient knows. Now they matter to you whether the patient knows or not. But for the patient, and again, we're talking about factors that contribute to the treatment effect. The patient needs to understand that. So if you're doing a pre and post, don't forget about telling the patient about the difference between the two and emphasizing it again, we get blinded to it as we go through Our days doing what we do, seeing the benefits we see each and every day with the patients, we see it hundreds of times. A patient's living their life and they have no clue about the objective assessment tools that you're utilizing. So if you're doing pre and post objective assessments, have that conversation and when you see improvement, ensure that the patient is also understanding and bought into that improvement. That's easy to do, but often kind of left at the front door as we're going about our day. Number two is what they call therapeutic alliance. This was effective communication and confidence that the doctor has when communicating with the patient. And this ties to the heart of what we talk about probably every single week on this podcast, which is your communication ultimately is the number one predictor of success. That communication can go to other healthcare providers, building referral relationships with the evidence based chiropractor. It could go towards communicating with your patient list in inactive patients, as we do with patient pilot for patient reactivations. And of course, the communication that you're having to the active patient there in the moment patients, they highlighted appreciated clear explanations of the diagnosis and the treatment plans. So having confidence and clarity, again, confusion kills. Conversion is what we say in the marketing world, but in the practice world, confidence and clarity are key. That's an easy way to remember that. So when you speak, speak with confidence, instill that confidence in your patient and then be clear. And this is a balance. You don't want to be clear to the point of leaving a lot out by simple oversimplifying. But also don't do the jargon thing. Every patient comes in, as you've seen, with an X ray or an MRI or a CT report, and they're petrified because they don't understand a single word on it. And that creates a lot of fear. You can counteract that. My example, not that you're gonna be shooting those images every single time necessarily, but the image report is an example of where confusion can really hurt the ability for a patient to feel confident. Right. They come in scared, not confident. So your ability to speak clearly, avoiding jargon with confidence is really, really important. Here's an example of kind of what that looks like. When I was at one of the orthopedic groups, a lot of what I did was imaging review and I would just sit down with the patient. I'd kick things off at the beginning of the visit by saying, great to meet you. We're gonna do three things today over the next 20 minutes. I'm going to get a better understanding of exactly what brought you in and what's going on. Number two, we're gonna take a look at those pictures we have up on the computer and identify what, what are the problems? And then we're gonna talk about what are the not perfects so you have a clear understanding. And number three, I'm gonna let you know exactly what I think you should do to find relief, whether it's here or whether it's somewhere else. So you can see that's just a clear and confident explanation of what's gonna happen. And guess what? That put my patients at ease. It put them in the state to accept and understand what I was going to say because it reduced the fear and apprehension that they had. Number three, factor adjunctive therapies. There was a lot of value placed on complementary therapies and active care like home exercises. So important to keep in mind, regardless of how you approach philosophically, the care in your practice, there probably are some things that you can either guide or recommend to help people. And that's just a great thing to do. The significance of the cavitation. Mixed opinions on this one. So there were some patients that came in and really liked to hear in this study that really love to hear that pop or cavitation. There were others that liked to hear it but knew that it didn't really matter. So depending upon the technique that you apply in your practice, this is important to help people understand. If you're doing a low force technique where there's not really a cavitation, address that in your conversation. Why would you want to address that? So you can diminish the confusion that the patient might have if they've been somewhere else or if they've heard that's what a chiropractor does, or watched a video online and you're doing something different, that's a confusion point. And that can lead to a patient not converting. And when I say that, that means not continuing care, ghosting your practice, not following recommendations, not referring people, all of those things are byproducts of confusion. So tackle it head on. And psychomotor skills, skills like patient positioning, preloading force and thrust specifications were critical. So when you are going about the actual care of what you do, describing it to the patient in a clear and concise manner, really, really important. All of these things just really lead to a better patient experience, which again, the cascade of that is that patients will stick around longer, meaning follow your actual recommendations without leaving too early. Two is that they'll refer a friend just because they get a decent result in your practice doesn't mean they're going to refer a friend. Getting a great result and having a great experience means that they're more likely to refer a friend. And all of that's really, really important because this study emphasizes that there is a multifaceted nature of effective chiropractic care. There's patient relationships and technical skills describing what's gonna happen with the care and treatment that you do, really important. And then the relationship that sits within that so they understand who you are, how you're benefiting them, and what the next steps are, are intimately critical to people getting a great result. So in this study, the average age, just so you know, is about 33 years old. And it was an even split, men and women. The primary issues people were coming into that practice with during this, for this study were low back pain, in order, low back pain, neck pain and mid back pain. All of the patients in this study did receive high velocity, low amplitude adjustments. So I'm going to come back around to a couple important things to keep in mind. The key findings of outcomes, perceived improvement. And there's a key word there, perceived improvement. Are you accurately describing and guiding your patient along with what's going on? That doesn't mean being disingenuous. It means actually emphasizing what you're doing. And often there are great clinicians out there that throw the baby out with the bathwater, so to speak. And it's like, well, I don't want to influence that. You do want to influence that. You absolutely want to influence the decision making of the patients coming into your practice, because that's how they're going to get the best results possible. So there were five main themes, again with multiple sub themes. Treatment outcome, therapeutic alliance. Let's go to treatment outcome, immediate relief and measurable change. So balancing those two out, therapeutic alliance, communication and confidence. The keywords there, adjunctive therapies, passive and active approaches. You get to choose. But doing and providing either guidance or the ability to do that in your practice, the ability to do that at home, however you want to approach it, led to a perceived benefit. Four was significance of cavitation. Again, this goes both directions. I think it's important because they brought it up in this study just to know you should talk about it. It doesn't mean you have to have a cavitation, doesn't mean you don't have to have a cavitation. But. But what it does mean is you need to communicate what you're doing to your patients. And then number five, psychomotor skills how are you positioning the patient? Preloading thrust technique. This ties into some sub themes in terms of comfort, et cetera, but being able to describe what's going on. And each one had a varying level of importance. However, each one was of importance to the patients coming into your practice. So for you, listening, recognizing the diverse patient expectations, and adapting your communication to improve patient satisfaction, absolutely critical part of the job. It's what you signed up for. And combining your spinal adjustments with additional therapies can enhance the patient outcome. And the beautiful part is you get to choose. There's a variety of ways you can go about that. That's up to you, based upon your experience, the patient's goals, and your clinical findings in terms of how you want to apply that. So all of these factors were really, really important in ensuring that patients got the best results. And this was, again, coming from the patient, potentially the most important source of truth. What are people expecting, believing and hoping for when they step into your practice? And I'll go beyond this study and say this extends to every aspect of how you run your business. What is the copy, the words, what's the pictures on your website, on your social media channels? When you converse with people in your community, do you have confidence and clarity? Do you have specificity around what somebody can expect when they come in? And do you have, I'm just gonna say at the base level, the testimonials to support things? I'm a big fan of Alex Hormozi in this case, where it's like, you can never have enough testimonials. I believe that forever. And he's done a great job describing that throughout all of his content, but ensuring that you are consistently gathering testimonials so that as you sit there with a patient and they come in, many people do come in somewhat skeptical, especially if they're not refer. Have a wall, right? Have every single testimonial you've ever received that's positive, print it out, hang it up, have it on a wall. That is a overwhelming installation, so to speak, of confidence from you into that new patient. And you haven't even said a word yet. So there are things that communication goes far beyond just the verbal aspect of what you say to a patient. It speaks into what they saw, experienced before they stepped in, as they stepped in, and then when they see you in that practice. So I love this study because it reinforces the idea that we're under the control of our own destiny. When we step into our practice, there are things that we can directly do each and every day that can improve the outcomes our patients are getting, improve our business and and just make things more fun. Why not have clear communication? Why not take the time to highlight the benefits of the care that you're providing to your patients, to them, with them, and for them. And why not utilize the tools in your tool bag you have available to the best benefit for your patients? So fantastic study. I'll drop a link down in the show notes if you have not left a rating or review for the podcast yet, I would love it if you would take a moment and do so. If you you can scroll on down. If you're listening on Apple podcast or itunes, just tap how many stars leave a line or two. That would be awesome. I love to hear from everybody out there. If you have questions you can hit me up jeff the evidencebasedchiropractor.com and before we wrap up, I want to say a few words about turncloud. They've created an intuitive EHR application where no one needs a user manual. You can learn more@TurnCloud.com I'll drop that link down below TurnCloud.com There are a bunch of fantastic EHRs on the market. There are also some that are that are not so fantastic. Turncloud is one that sits in that first camp. A great tool, simple to use and they have done a great job making it as efficient as possible for you in your practice. So turncloud.com I hope you have a fantastic week in practice and I will talk to you soon.

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