https://www.listennotes.com/e/879579513e7a486f89689997a242beb8

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 great research. Brand new study out of Sweden around the effectiveness and cost effectiveness of chiropractic care, physiotherapy and their combination for people with chronic low back pain. It's a great study, a lot of take home messages, clinical pearls and statistics you can utilize to communicate better with your community. Now before we get started, I will say a few words about neck care. The best objective assessment tool, the cervical spine bar none. The their hardware and software is awesome. They provide reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. If you have not checked it out, please do so. Neccare.com, i'll drop that link down below. But as I said at the top on today's episode, we are talking research. Brand new study. Of course I'll drop this link down below as well. And it was a multicentered randomized control trial. I always like to see that RCT randomized control trial. They had 88 participants and they were trying to figure out which approach is best not just in terms of outcomes but cost. Now full disclosure and I'll probably repeat this in a little while, I'm not a big fan of that. The cheapest is the best. I just that's not the way I go about things. Matter of fact, in the practice that I own, we don't take insurance. We're cash based practice. I believe those who pay pay attention and that's just my personal belief. But in this case they also looked at cost. So I don't want to necessarily highlight reduced cost always as an abject benefit. I think it's a factor in a decision making process, not necessarily always a benefit. Just my two cents. So if you ever wondered whether chiropractic care combined with physiotherapy or physical therapy in the States here is worth it. This study starts to provide some answers. So we'll kind of set the stage with some basic facts, many of which you are probably familiar with but bear repeating. Chronic low back pain affects nearly 30% of people worldwide and is one of the leading causes of disability. And I want to repeat that real quick. Chronic low back pain, 30% of people that means 30% of people have gone more, by definition, more than 12 weeks, more than 90 days, more than three months with consistent back pain. That's a big deal in 30% of people worldwide. There's like six and a half back billion people on planet earth. That is a staggering number of people that not only have experienced spinal pain, Right. Experiencing it and getting over it is one thing. Lapsing into chronic pain, where you have fear, avoidance behavior, you are dramatically more likely to be taking medication and go to advanced interventions. You're incredibly more likely to have the mental toll of that depression, disability. This is a big, big deal. So again, I know I say this a lot on the podcast, but it's really important. Sometimes us as chiropractors, we become blinded to like, yeah, everybody has back pain, whatever. 30% of people have chronic low back pain. That means they've already dealt with it, gone through a process, not found relief, and they're still there. And most of the time that goes to start a cyclical downhill trajectory unless they receive the care necessary. And quite often, if I'm just blunt about results in pills, medications, injections and surgical intervention. Not what they really need, which is probably some cognitive therapy, but also movement based healthcare. What you and I do, I believe it's just a massive continued opportunity. I don't believe we've done a great job really illustrating that to people. And that's just based upon the facts. If you look at 15% of people have ever seen a chiro fracture, 90% are going to have spine pain, 30% of people have chronic low back pain, and we haven't even got to the performance benefits yet. You can tell we're just under serving people. And what does that mean? It means our communication's not on point. So hopefully that's what this podcast can bring each and every week is at least a little bit of impact in terms of how you communicate to the people in your community on behalf of your practice. So many people that do have chronic low back pain, or many people that have spinal pain to begin with, recover within six to 12 weeks. That's the good news. But 40% still report pain six months later. And 31% continue to experience pain during daily activities even after their recovery, quote, unquote. So this study was based in Sweden, and Sweden, like many other countries, faces significant economic burdens due to chronic low back pain. And they estimated it at 5,400 bucks per person per year. I think Sweden is like the cron or the crone. But anyway, it's $5,400 of their money each and every year. So despite many treatment options, things like physical therapy, spinal manipulation, behavioral therapy, the most effective and the most cost efficient treatment remains a little bit unclear. So this study aimed to really say, hey, we got chiropractic, we got physiotherapy, combination of both. General advice, how do these work together and what are the results of individuals that experience one or a combination of each. So this had 88 adults with chronic non specific low back pain for at least three months duration. And the setting was 10 primary care rehab units across Sweden. And they basically broke these people out into four groups. One received chiropractic care, so spinal adjustments. One received physiotherapy based on stabilization, mobility and posture training. Three was a combination third group, combo treatment, both Cairo and physiotherapy, and and fourth was advice only written in verbal advice about managing chronic low back pain and staying active. And they measured the results in a few different ways. One is through an oswestry disability index. Good old ODI for disability. They did a health related quality of life, a quality adjusted life years, a cost analysis and the data was collected, baseline, three months and six months. So let's dive in. We'll go one by one and we'll start right at the top. We'll with the disability reduction, those ODI scores, this is great news. All groups saw improvements in disability after six months, but none of the differences they highlighted were statistically significant. So disability score reductions ranged from about six to a little over 12, meaning everyone felt some degree of improvement. The combination treatment group saw the largest average reduction. And that's important. What was the combo? Remember the combo was chiro and, and physiotherapy. Now when I say physiotherapy, I wanna go back to that really quickly because they said focused on stabilization, mobility and posture training. Does that sound something like you might offer in your practice? Right. So of course there's an overlap between approaches in traditional physical therapy and chiropractic. What I find to be the primary benefit, my experience, my opinion with chiropractic is that we're able to really focus on the segment, the region and holistically the segment that's through the chiropractic adjustment. It's not long lever, it's short lever, right? We're able to get in there and adjust, take care of, manipulate, whatever you want to say. We're able to get in and impact a spinal joint at a singular level. Now the specificity of those adjustments, obviously you know, there's Impact beyond just a single joint when you deliver adjustment. But there is an impact at a joint level. It's not just trying to exercise around a joint that has biomechanical challenges. Being able to reduce adhesions in the facet joints, being able to pump the disc through that motion, getting into the paraphysiological space and then moving into your stabilization, mobility and posture training. That's where I'm like yeah, no kidding. The combination got the best result because you absolutely need to address what's going on biomechanically at a segmental level. My opinion before you move on to stabilization, mobility and posture training. There's exceptions, but that is the rule and we continue to see that showcased in the research. So second thing that they took a look at was the quality of life and the combination treatment. Drumroll praise resulted in the highest quality of life gain as well. Quality of life difference between combination treatment and advice was.008amodest but meaningful gain. So again, combo treatment. And here's the good news. There's a lot of ways that you can offer mobility, stability, posture training, et cetera. Some of you probably have rehab, high tech rehab in your facility. Some of you listening, you have low tech. Some of you, you might have like a clinic gym hybrid. Some of you maybe you're providing digitally through an app or whatever tools you might use, web exercises being one of them. Maybe you're providing follow up that way. There's a lot of different ways that you can implement it and it doesn't always have to be done in the four walls of your practice to be effective. But it is important to understand that if you're trying to get the best results for your patients, being able to guide and direct them, I'm going to say beyond the adjustment, you need to be there to deliver the adjustment unequivocally. But you have a lot of great options once that is complete. That is your unique skill set. Aside from the diagnostics, aside from the communication, being able to deliver a chiropractic adjustment is a unique skill of a chiropractor or spinal adjustment. In that case, everything that you do beyond that you can utilize again other people's skills and techniques. Technology, there's a lot of ways to implement you can get super creative and really help your patients get better results. And what does your patient better results mean? It's based upon your findings during the exam and their goals. It's not always bringing pain from 10 to zero. It can be about improving functional ability. It can be about sports performance. So not to get off on a tangent, but I think it's important to understand that the third thing that they looked at was cost effectiveness. Again, I take this with a grain of salt, but from a healthcare perspective, interestingly, combination treatment was the most cost effective. Why is that? We'll get into that in a moment. But the total direct cost over six months. Again, I apologize not knowing exactly what the Swedish unit of commerce is, I think it's a cron. But combination treatment was basically a little bit over 3,000. Chiropractic care was 3,100, physiotherapy 3,600. Advice only 11,000. Why was that the highest cost? They say likely due to surgical interventions. You just tell somebody about how they should take care of their back, they're probably not gonna do it, and then they're on the fast track to advanced intervention. So really looking at the combination treatment, it highlights the effectiveness based upon the cost. Again, I'm not a big fan of racing to the bottom in terms of cost, but what it does showcase is when there's a combination treatment, people are getting well and they're getting well. And that's highlighted in the fact that they're able to cost contain. And I just think that that's an important thing to highlight because it is in the research and it's important to have that understanding. So the other thing key to keep in mind as I, as I highlighted was the physiotherapy was actually significantly more expensive than chiropractic care. So when you added chiropractic care in it, it reduced overall cost for both in a way that was super meaningful. So combination care, what are the implications? Well, combination care might be the future for managing low back pain, especially for best long term results. And this highlights the importance of collaborative care. And again, collaborative care doesn't mean a patient needs to leave your practice. There's a variety of things that you can do in your practice under your license to enable them to get everything that they need. And more. Chiropractic care alone still showed super strong results, especially considering the low cost and the quality of life improvements. And it just continues to highlight that patient education is key. And while short term relief is great, educating patients on combined strategies can really help them get the best long term outcomes, which I think is what we are after. So a couple things to keep in mind with this study, pretty small sample size, 88 patients involved. There also was a decent dropout rate in terms of being able to collect the information at three and six months. So those are important. To keep in mind, some of the final takeaways were again, combination treatment offers the best value. And even though chiropractic care alone didn't dominate everything, the cost effectiveness and quality of life improvements were really meaningful and they were best in class aside from the combo treatment. And you can absolutely collaborate with physical therapists. You can bring in strength, as I like to think about it, the balance of strength and flexibility that also goes into mobility and posture training with all of those things are comfort places for you and I as chiropractors. So being able to put together the systems and processes in your practice to deliver the best education, the best care, the best guidance, the best plan of action for every single patient that walks into your practice is absolutely paramount. So this was a great study. Again, I'll drop that link down in the show notes if you wanna check it out. And before we wrap up, I'll say a few words about turncloud. Turncloud has minimalist design without being sparse and they create an intuitive EHR application where nobody needs a user manual. I love that. You can Learn more at turncloud.com, schedule a no obligation demo with their team Connect and see if it is a good fit for you. If this is your first time listening to this podcast, thank you for tuning in. If you're a longtime listener, I want to say thank you even more for tuning in. Over time my big ask of you will be leave a rating or review. I love to hear from you. So if you scroll on down, if you're listening on your phone, tap how many stars, whether you're on Spotify, whether you're on Apple Podcasts or wherever you are listening. That is awesome and it helps more and more docs find out about this podcast. If you have any direct questions, you can always hit me up. Jeff the evidencebasedchiropractor.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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