How Patient Demographics Influence Treatment Decisions | Podcast Ep. 407

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we are back with more research. A brand new study that came out in chiropractic and manual therapies and it's all about patient and provider characteristics associated with what intervention is chosen in chiropractic practices. We're going to break down exactly what that means, how it applies to your practice and some of the take home messages, as well as a few of the surprises that I learned in this brand new study. On today's episode. Before we get started, I want to say a few words about patient pilot by the smart chiropractor. If you would like a daily report showing you your patients who are ready to reactivate into your practice, head over to thesmartchiropractor.com and schedule a demo. That is literally what we do. We send weekly emails and we generate daily reports showing you the first name, last name of everybody who is ready to reactivate into your practice. We do it in an automated fashion, we make it easy for you and we do it for more chiropractors around the world than anybody else. So if you'd like to get started as we head into Q4 to maximize your patient reactivations, which I think is a really good idea, head over, do a demo thesmartchiropractor.com and I will drop that link down in the show notes. Additionally, I'll drop a link to this study down in the show notes which came out in chiropractic and manual therapies just over the last month or so. And the official title is Patient and Provider Characteristics Associated with Therapeutic Intervention Selection in a Chiropractic Clinical Encounter. It is a cross sectional analysis of the coast and O Coast study data. That's an acronym that we'll talk about in just a moment. But this really tries to highlight what goes on when somebody comes in to a chiropractic practice. What goes on? What goes on the most common. What goes on the least common? And is there any correlation between how the patient shows up, who they are, so to speak, demographically, and their treatment that they receive? And this is a great study that highlights that. So as defined by the who, which is the World Health Organization, Chiropractic is, quote, a healthcare profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. I want to pause there before we get into the study. That's a really Great definition in my opinion of chiropractic. Now I like to say we are a movement based healthcare profession, so maybe I try to sneak that in there somewhere, but I could not agree more. The diagnosis, treatment and prevention. And that's a key component when we talk about prevention because we've talked a lot about maintenance and wellness care this year and how some docs pride themselves on low PVAs and not getting into the realm of maintenance and wellness as if it's not patient centric. I don't believe there's anything more patient centric than actually highlighting to people the truth. Gravity is undefeated, time is undefeated. You are probably going to do things to your body over time that create challenges. The stressors. Right. And, and that is a tale as old as time. Yet many people don't internalize that. And that's a paradigm that we bring to the table as chiropractors that really nobody else does. And it should not be diminished when we look at the prevention and the importance of that. Additionally, they highlight the neuromusculoskeletal system. I couldn't agree more. It goes beyond biomechanics. This is about neurology, this is about the musculoskem, this is about the skeletal system and the effects that that has on disorders, AKA diseases, AKA diagnosis codes and on general health. And that is really when we talk about a chiropractic lifestyle. And quite frankly, I don't care where you fall on the philosophical spectrum of chiropractic, it's different. You know, a minority of people by definition see a chiropractor less than 50%. As a matter of fact, it's about 10 to 15% maximally. So that is an alternative being within a chiropractic paradigm and lifestyle. And there's nothing wrong with that. I actually think it's one of the best things we can do is continue to highlight and talk about it. Especially as we pull that together with what we see in the sports chiropractic realm. And we pull that together with what we see within what I'm going to call movement based healthcare. That's a message that is needed, it is necessary and it shouldn't be shied away from. Now we know that there's also about a hundred thousand chiropractic licenses worldwide, aka chiropractors. I think there's about 40,000 actually practicing full time docs in my opinion. And that's represented across 90 countries, which is pretty impressive. We also know as they highlight that us as chiropractors, we use a variety of techniques. Those could include spinal manipulation, joint manipulation, it could be mobilization, soft tissue techniques, advice, education, exercise prescription and other specific modalities. Things like dry needling, laser shockwave, all of these are within the realm of who we are and what we do as a chiropractor. And, and we also know that spinal manipulation or joint manipulation is one of the most frequently utilized techniques and for good reason. But it's about 80% of clinical encounters is revolve and include joint manipulation. And other interventions happen in about 35% of clinical encounters. So about 80% of the time somebody visits a chiropractor, they're probably gonna get an adjustment of some type, whether it's spinal or extra spinal. And again, I'll tie back to a talk I recently out at Chirofest out in the great Pacific northwest. Awesome room, 600 chiropractors in the room. And we talked about research and I plowed through a ton of studies. And there is something different between mobilization and manipulation in the literature. It just affects the body in a different way. When you get in there with the high velocity low amplitude adjustment, it stimulates things differently than just moving through a range of motion or simply going through immobilization. Not that there's anything wrong with range of motion or mobilization, but. But there is something different, dare I say special when you get in there with the high velocity low amplitude adjustment because it provides the body with different input, the speed of that, the ability to get into the paraphysiological space and how that affects. Not only that, if you're talking about the spine, that segment, when we look at what's going on in the peripheral nervous system, when we see that, how that impacts and influences the central nervous system, you even changing biochemical markers in the brain altering cortical drive, there's just so much that goes in and this gets to the width of. When we talk about mechanisms of action and why it's like so difficult to pin down because there's so much going on. That's not a bad thing, it's a good thing, but it makes it challenging in the research for sure. And that's why in many cases we're gonna see 80% of clinical encounters have a chiropractic adjustment, not only is what we're taught primarily, but it's a really, really great tool. Now what does coast and OCOST stand for? As we talked about in the title, the Chiropractic Observation and Analysis Study. That's a good use of creativity there. And the Ontario for the OCOST Ontario Chiropractic Observation and Analysis Study. These were cross sectional studies with data collected from nearly 8,000 patient visits. So pretty deep in terms of the data that they were able to gain when they whittled that down, they eventually had 6,400 unique patients attending about 7,900 8,000. We can call it patient visits. What did these patients look like, so to speak? Well, the mean age was 43.7 years old, and 58% of the patients that they analyzed were female. And patients had a 28.3%. Let me rephrase that. 20%. 28% of patients presenting had at least one comorbidity. And more than half of the diagnostic encounters had patients that were either overweight or obese, 34% overweight and 23% obese. I want to pause there. This is kind of incidental to this study, but it's really important to highlight a couple things here. One, understanding comorbidity. With nearly 30% of patients presenting with at least one comorbidity, that means there's probably more going on than just the pain that they're describing in your encounter. And understanding that and helping ultimately guide patients when they have comorbidities to the best of your ability is a really, really great idea. It's not only gonna help you get better results, they're gonna be happier, leave more reviews, give more testimonials, more referrals, but it's just the right thing to do. The second component, and not being myopic. Let me pause on that. Not being myopic, in my opinion, is one of the most important things we can bring to the table as chiropractors. They can go say, I have hypertension and get a drug somewhere when they're coming in, and you discover that they have fear, avoidance behavior and movement, and they have low back pain, and you can help them overcome that fear, for example. That's not a comorbidity, but I think you get my point. When we can look at things through a more holistic lens, it's a really, really valuable skill that we bring to the table. The other component, with 34% plus being overweight, 23% plus being obese, this is a big deal. And when we think about weight, there's so many lenses to look at this through. Number one is in general, it makes relief harder. When we see the joints impacted at a higher rate over a longer period of time, as we age and weight goes up and we become less mobile, these are really tough challenges. So these start to become compounding and you want to break that down and break that apart. Now, all of us are not, I'm going to say weight loss experts, as chiropractors, necessarily, maybe you have a weight loss program in your practice, but helping people understand that weight is beyond aesthetics alone. And I know it's a delicate subject, and it might not be a subject that's gone into with every single patient in your practice, but it's important to at least be aware and not be blinded, because we see it so often over 50% of the time that it can play a critical role in your ability to help somebody get well. And helping them understand that things might take a little bit longer is just proper expectation setting, which is one of the most important things we can do. So the most common diagnostic grouping that presented was no surprise. Musculoskeletal back challenges 58% of the time. And they had non musculoskeletal complaints, 3%. Health maintenance and prevention, about 3% as well, 2.5%. So across all diagnostic encounters, manipulation was the most common technique utilized. In this study, it was 63%, followed by soft tissue techniques at 58%. Excuse me, manipulation was 63%. Soft tissue techniques were 58%. Surprisingly to me, a couple things. One, that's actually lower than I would expect for manipulation only at 63%, I would think it'd be 80 to 90% soft tissue techniques coming in strong, nearly 60%. That's great because soft tissue is an important component of things. I just hope that soft tissue isn't overtaking the necessity to get movement into the joint, so to say. The other aspect that was surprising to me is flexion distraction, acupuncture, supportive devices, less than 5%. I would think that 20 to 30% personally of the profession would be using flexion distraction. I use it in my practice. I think it's a great tool. Not everybody's gonna use it. I totally get that. But I was surprised to see combined when we look at acupuncture, flexion extraction, it was less than 5%. That was a bit shocking to me. So across all, when we look at the patient archetypes, across all conditions, patients were actually less likely to to receive manipulation if they were female, which a majority were female. So that's interesting. Of older age, presenting for the first time, have a new complaint, had one or more comorbidities, or were underweight or obese. So either extreme there. Conversely, mobilization, education and other chiropractic techniques were utilized more frequently for patients presenting in those cases. So this is Interesting. I don't really understand the female male component. The older age, potentially. I could see that with a risk of a stress fracture or something to that effect, presenting the first time. That's wild to me. New complaint, comorbidities, underweight or obese. Now, in the case of underweight or obese, there's a certain time where there's table limits, right? So if somebody is morbidly obese, that can be very challenging to deliver an adjustment, especially if you're a smaller chiropractor. But it was very interesting to see that, that all of those actually made it less likely that somebody would receive an adjustment, but more likely that they'd receive other things. Now, I think it's fantastic that patients were receiving things such as mobilization advice, education, ancillary care. I think that's really great. I just was surprised to see that those were the factors that affected how likely somebody was to receive an adjustment. And chiropractors who were in practice for more than five years were less likely to report using prescriptive exercises. Also interesting antidote. Not totally surprised by that, but it was interesting to see that nonetheless. So I think this study had some really, really interesting points. It kind of highlights the fact of that, as with many studies, this is not the end of the story, but rather the beginning of the story. They don't have too many conclusions. This was looking at the data to establish what was going on. Now then subsequent studies can build upon this, take this information and data and see if we can stratify what's really going on when somebody comes in. And this is an interesting mode of thought because in my opinion, looking back at data such as this, it helps us really get a grasp of what other people are doing. And many times as chiropractors, we can be pretty siloed in terms of we're in our practice by ourselves, 76% of us are sole providers. So we don't have a lot of access to what are other chiropractors doing day in and day out besides talking with a friend or visiting a seminar? At which point, how accurate is that data? Well, pretty accurate, but I trust it a lot more when they're looking at the codes of actually what's going on, because there's no bias to that. So this study was an interesting first step in understanding what are the factors that affect the treatments delivered in hundreds of chiropractic practices through thousands of patient encounters. So, interesting study. I'll drop the link down below if you want to check it out. Additionally, as we wrap up. I want to be sure to let everybody know heading into October, if you are looking to build out your revenue, you have to build your team. And I know I can speak to this personally right now. Team building is one of the hardest things to do out there. Whether you are hiring an associate, whether you're hiring a chiropractic assistant or whether you want to, you're a lone wolf maybe and you want to bring or you could be a big practice and you want a virtual chiropractic assistant, which many docs are unaware that that's out there. But all three of these are available right now at chiromatchmakers.com youm can head over, schedule a discovery call, have a conversation and see which one's right for you. The only way to build over time and grow your practice is to do it through a team. There's only so many hours in a day, there's only so much you can do and when you can build out a fantastic team that can help you accelerate your progress towards the goal. And a team is not an expense. Let's be clear. The best teams are actually investments in your future. So if you're looking to find a team, have the right people there, which is obviously a really important component of this, head over and schedule a discovery call with chiral matchmakers@chiromatchmakers.com, i'll drop that link down in the show notes. I also want to give a huge shout out and thank you everybody that participated in our little sweepstakes a few weeks ago when I asked, hey, can you head over, hit up a review, you can get back to me and I'll shoot you some swag. All of that has been shipped. All of that should have been delivered by now. So if you haven't received it, please let me know. Otherwise, thank you so much for participating. Thank you so much for being a chiropractor. Have an awesome week in practice and I will talk to you soon.

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