Does Research Support Maintenance Chiropractic Care? | Podcast Ep. 146

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with an awesome brand new piece of research that just came out in September of 2018. Huge kudos to the research team that put it out. It touches upon maintenance care, chiropractic and you're definitely going to be interested in the results. But before we get started, I want to do a few items of housekeeping. A big thanks to Life University for having me up this past weekend. I was a little bit stressed out. I had to teach four hours. I've never done four hours before. But the docs up there were awesome. It was a completely packed house which is always very, very welcoming. Talked MRI essentials, a little bit of interdisciplinary communication and research. So super cool. Thank you to the entire team up there and everyone that came up and said hi afterward, listening to the podcast, maybe reading the book. Thanks a ton. It was a great, great weekend. Additionally, I wanted to give a huge shout out to Rock Tape. Rock Tape was there as well. And if you have not picked up your tickets for Rock Stock in Miami, time is starting to run thin and so are tickets. It is October 26 and 27 in Miami. I'm going to be there filming. Come on down, hang out, say hi. It's gonna be awesome. So be sure to come down and hit me up if you are at jeffevidencebasedchirofracture.com but as I talked about at the top, we have some exciting research to get to today. Paper we're gonna talk about is titled the Nordic Maintenance Care Program. Effectiveness of Chiropractic Maintenance Care versus Symptom Guided Treatment for Recurrent and Persistent Low Back Pain. A pragmatic randomized controlled trial. This came out in September of 20 and I will also link this paper in the show notes. Let's break down that title a little bit. Effectiveness of Chiropractic Maintenance versus Symptom Guided Treatment. So basically what they're saying there, if you have periodic chiropractic care versus only just when it hurts, basically what happens. And it's an rct, a randomized controlled trial, which is that top tier of research that we always like to see. Additionally, the population they went after was really looking at recurrent and persistent low back pain. I'm gonna call that Chron. And that is very interesting, right? Because a lot of people, what also the research has historically shown is many people don't have full remission from a bout of back pain. They might have a period of remission, but Once you've had a back injury, let's say it doesn't mean you're destined to a life of back pain, but it's more likely than not that you may have another instance in the future. So this is a really. They said the word pragmatic in the title and I agree with them 100%. It's really exciting and we actually fast track this for all men members of the emnospace chiropractor. We wanted to make sure that they were aware of this research study and certainly that they could get it out there to the people in their community as well and share some of the findings and their take on it. So we know almost 20% of people who experience low back pain will be at risk of developing a chronic pain pattern. Almost 20% of people who have back pain are gonna go into that persistent chronic category. So that is tens of millions of people. There is no shortage of those individuals hanging around. We also know historically chronic low back PA has been, the treatment has been symptom guided and based upon exacerbations. Hey, primary care doctor, hey take this medication when it hurts, you know, and hey, go to physical therapy if it hurts. From a medical side of things, it is very, very symptom guided. And basically when there's an exacerbation, there's an intervention. Chiropractors, little bit of a mixed bag, right? There are many chiropractors out there that highly promote maintenance care. There are some that do only relief care. But I venture to say a majority of docs res somewhere in between, they're gonna take into account the history of the patient, what's going on with the patient, what's the patient's goals and aspirations, kinda put that all together and really work with the individual to create the best plan of care possible. So that's why this research paper again is so exciting. Cause it's very, very pragmatic. So new research does indicate that maintenance care may provide the best long term result. And when the cat out of the bag will hit a few quotes in a moment. Periodic chiropractic care was shown to reduce the average number of days with low back pain 12 month period by nearly two weeks. So when they looked over a year period, if you had maintenance care, you had almost two weeks of reduced pain. You are two weeks less pain than those individuals who only had the symptom guided. So this type of care, as they say, may be best with recurrent and persistent low back pain. Especially for those individuals who respond well to an initial trial course of Care, just like we talk about at the evidence based chiropractor with all our members. As you start out, make sure that you're getting out there telling the other physicians, we're starting with a trial course of care that doesn't limit you, but what it does is it shows that you're going to be reactive to what's going on. Hopefully we are proactive, but as we treat the patient, we're gonna come to understand who they are, where they're going and how we can fine tune our care plan to make sure they're hitting all of the results that they want. True patient centric care. So let's look through a few quotes from this paper because it's a good one. Researchers found, quote, maintenance care was more effective than symptom guided treatment in reducing the total number of days over 52 weeks with bothersome non specific low back pain. That pretty much says it all. But let's dive a little deeper. They also found, quote, exactly how maintenance care works is poorly understood. But the hypothesis is treatment may improve biomechanical and neuromuscular function and address psychosocial issues, excuse me, thereby reducing the risk of relapse into pain. So that's an important quote. Number one, it touches on the good F word, right? Function. It is about function and functional outcomes. That is the benefit people are looking for, not the features of what we do as chiropractors. In terms of technique, they want the benefit, right? They want the results. Less pain, more functional ability. Interestingly, they also point out psychosocial issues. So as people again, respond well and feel like they can do more, that becomes a self fulfilling prophecy. Dr. Greg Layman talks about it in terms of, you know, we're not broken spines waiting to have pain, but we are dynamic individuals. That's what he says. I'm going to take it one step further and say, you know, we're dynamic individuals meant to be so, so resilient. And understanding that once somebody's been in pain, understanding they are resilient and they can become functional again and resilient again is so, so important. Finally, the researchers found, quote, for patients with recurrent and persistent low back pain who are selected according to evidence based criteria, maintenance care should be considered as an option for tertiary prevention. So again, just another statement supporting the fact that in individuals who have chronic persistent low back pain, they undergo some chiropractic care, they respond extremely well. The research showcases this is not the first paper, this is a great new one. But there was a paper a few years back that showcased the same thing. Talking about how we as chiropractors are in a great position to evaluate, treat and detect an emerging problem, thus preventing future episodes. I'm really close on that quote, if not 100%. So every time that we have seen in the last few years maintenance care within a chiropractic realm being examined, it seems to showcase that there are clear benefits for it. Now of course this research paper does touch on the fact that hey, when you go through some maintenance care, it's going to perhaps be a few more visits to an office than if you just do the recurrent right, because you're keeping up with your maintenance. But in my opinion that is a small, small price to pay to maintain function, to maintain ultim ultimately those psychosocial issues, which I'm gonna say is a positive impact on your life, you think you can do things, you're gonna enjoy your life more and certainly when you have two weeks less pain per year, if you go through with some maintenance care as opposed to just the yo yo cycle of going through and receiving symptom based care just during exacerbations alone, it's a huge, huge impact point. Now of course this research paper is not gonna change the tide of insurance reimbursement tomorrow, right? So you still have to docum into a cord, make sure that if a patient is going out of active care and they're coming into a maintenance care, that's going to be typically when they change over to a cash paid patient. Most insurance plans don't pay for maintenance care. So be careful about that and be careful and make sure that you are communicating what you are doing, the why behind what you do, the why behind your recommendations to your patients so they understand it. Certainly having research like this in hand, listening to this podcast today, hopefully and having it in your mind is a great opportunity to start those conversations with the people coming in and out of your office. Additionally, when reaching out to other healthcare providers, everything that we do at the evidence based chiropractor, I think it's important to get this research out there now. I also think it's important to explain it. So you have to take the content, right, the content being the research in this case and put it in the proper context. You don't want to, you know, scare somebody off, let's say by, you know, they're thinking maintenance care on every patient from visit 1, those infinitely long treatment plans that nobody can wrap head around. You don't want to go all the way there. You want to make sure that you're explaining, hey, what the research has showcased is exciting. It's new. We see that people with chronic low back pain respond very well to maintenance care. In our office, we're going to make sure to do a thorough examination, we're going to take a thorough history, and we want to make sure that they are responding early to care. That indicates that they are going to respond well into the future. And by the way, if we hit a roadblock along that path, we're happy to make a referral to your office or get a second opinion. Again, all of this is just about communicating what's out there, communicating how you are taking care of people in your practice. That's one of the core tenants in what we've seen in the research. As far as MD and DC relationships, communication is absolutely clutch. So when we hear about papers like this, when we understand papers like this, it's awesome, it's exciting. It showcases time and time again that now is the best time to be a chiropractor. But please make sure that you are taking this content, getting it in the proper context so that the healthcare providers in your community can understand where you're going with it, so your patients can understand where you're going with it. And hopefully information like this helps you in your practice day to day, feeling confident with what you're doing, making the best recommendations for your patients, and ultimately having a better practice for it. So that's all for this week. If you have not left us a rating or review on itunes for this podcast, click over and do it. I would greatly, greatly appreciate it. It helps more and more docs listen in. We are still over 10,000 DOC each and every week, so thanks a ton for listening. I hope you have a great week in practice and I will talk to you soon.

We appreciate you joining us for this episode of the Evidence Based Chiropractor. Learn more tips for explosive practice development at the evidence basedchiropractor.com you can also join the Premier MD monthly membership, enabling you to use what you just heard to maximize results in your office.