Neck Pain & Continued Care: Key Clinical Indicators | Podcast Ep. 408

Foreign hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langme. This week we are back with more research and another brand new study that recently came out in chiropractic and manual therapies. I'll drop a link to this down in the show notes but it is all around clinical indicators for recommending continued care to patients with neck pain in chiropractic practice. This was a cohort study. Lot of great little clinical pearls. Take home messages, interesting things to think about when you approach maintenance care or continued care with your patients. We'll dive into all of that and more on today's episode. Before we get started, I'll say a few words about Patient Pilot by the Smart Chiropractor. We recently made a massive upgrade to Patient Pilot where we deliver daily reactivation reports. So if you would like a report showcasing the names of your patients ready to come back into your practice, you want to head over to the smart chiropractor.com and schedule a demo Anytime somebody in your email campaigns clicks, call the schedule or click to schedule in the previous 24 hour period. We send you and your team an email the next day letting you know exactly who those patients are so that you can reach out in a patient centric way. Many will just obviously click to call, click to schedule, end up back on your calendar that way. But staying in touch with top of mind and staying communicative with the most valuable asset you have in your practice. Your patient list. It's one of the most important things you can do if you're looking to build your practice without being overly stressed on paid advertising and conversion metrics. It just makes sense and we can deliver results for you. If you'd love to find out more, head over to thesmartchiropractor.com, schedule a quick call with our team. We'll ask you a few qualifying questions, make sure we think we can drive the best results for you and if so we let's get you started. Thesmartchiropractor.com, i'll drop that link down in the show notes. But as I said at the top today we are talking all about research. The title of this study is Clinical Indicators for Recommending Continued Care to Patients with Neck Pain in Chiropractic Practice. This was a cohort study. It just came out hot off the press 2023 and basically they look to analyze what's going on. We know a lot. Let me phrase it this way, we know a lot of what goes on with maintenance care relative to low back pain. But this was regarding neck pain. So it was a little bit of an interesting take. And they found some differentiating factors between how us as chiropractors approach maintenance care or continued care with neck pain versus how we approach it with low back issues. So that is what I found supremely interesting. So in chiropractic practice, patients are often recommended maintenance care by definition. That's after the optimal benefit is achieved from the active care plan. And such a care plan usually lasts two to four weeks. And the goal of maintenance care is a couple different things. It's of course, to reduce the risk of relapse, to maintain optimal daily function. And that's really what we look at when we look at maintenance care. I think there was a alliteration in one of the research studies that was the prevention and, you know, prevention and proper preparation to avoid future issues. And I think believe that that really is the case with maintenance care. Here's the deal, and this is what I say with patients all the time. Gravity and time are undefeated. So if you come into my practice, if you come into the practice that I have and we see that you have an issue, we very likely can take care of that issue most of the time, especially if it's neuromusculoskeletal related. However, gravity and time are undefeated and many people don't change their behaviors and lifestyles. That's where maintenance care is a really good idea, as we've talked about on, I think more maybe this year on this podcast than in any previous years. And is maintenance care effective? I don't even think it's effective. I think it's practically mandatory for most patients now. Mandatory meaning it should be recommended for most patients. And when we look at low back pain normally, this is when people have maintenance cares recommended historically, when patients have recurrent or persistent low back pain. And it has been concluded in previous studies that maintenance care is effective at reducing the total number of days with bothersome pain over a year's time. So does it work? Absolutely. Is it recommended with the right patients? Absolutely. Is it something that's a conversation you should be having? In my opinion, Absolutely. But many times I find docs wait until the end of active care to even mention maintenance care. This is not a good time because at that point, even though you're doing that with the best interest of the patient in mind, many cases it works the complete opposite, where patients feel as though now there's a quote unquote cell to maintenance care. And the irony being that's exactly what you're trying to avoid by often speaking about it late in the active care plan. However, that's exactly the way it comes off to many patients. So my belief is maintenance care should be discussed practically from the get go. At least it should be addressed now. Doesn't mean you're necessarily saying that maintenance care is the best thing for them on visit number one, where you haven't seen how they're going to react, how they are going to react to the care that you deliver over the active care plan. But I think it's important to plant those seeds super early. People need to just know the truth, which is time and gravity are undefeated as you come in. If we see that we're able to get the gains, we expect to help improve your quality of life, get you back to doing those things that you love. For our patients that receive the best results over the longest period of time, they typically come in on a maintenance basis as well. Because you want to continue to do those things and time and gravity will continue to weigh on you and chances are you're going to go back to doing the activities. Many people don't change their jobs dramatically, change their diet, change their movement patterns, all in the course of the active care plan where it's like, oh my gosh, you've changed your life so much. That's not the reality of what happened. So this is where people go back to doing the same things that they did before they came into your practice. We do a wonderful job helping get them out of pain and just a tune up every now and again with maintenance care can help keep them out of pain and functioning. To me, that is an awesomely powerful thing and it's something we need to be addressing super early in the care journey, so to speak. So maintenance care, historically in low back situations has been offered to patients who experienced previous pain episodes, long pain duration, or have shown improvement during the initial treatment or during the active care plan, which makes a lot of sense. Now. In this study, they were analyzing neck pain and just how chiropractors were approaching this. And the chiropractors that they had in the study were mainly female, 64%. The mean age was 39 years old. And most chiropractors in the study had graduated from a college in the United Kingdom and had been in practice more than five years. And the sample size was just shy of 200 total patients. And what they found was after four weeks, 23% had an appointment set up for continued care. These people were most of these patients were mostly female, reported previous pain episodes, a longer pain duration, higher pain intensity, and a higher number of musculoskeletal pain sites compared to patients without recommendations for continued care. So those were some of the factors that they, that they found. They also found that a long duration of neck pain showed a significant association with being recommended continued care. So the duration for this study with this sample size with these docs showcased that the duration of pain was one of the most prominent factors that highlighted whether continued care would be recommended. Now, interestingly, none of the chiropractor characteristics, gender, age, country of education, number of years in practice, none of that had statistically associated a correlation with recommending continued care. Which is really interesting because I think here in the States, anyway, I think it fades off as we get more as we age and become veterans in the profession. But especially early on in practice, there's like this thought of, wow, if you go to this school or that school, you're just going to approach patient care in such a wildly different way as time goes on, I've seen that to be less true, because while you might be taught a certain way, I've seen docs from every educational institution across nearly the entire philosophical spectrum of chiropractic. Now, is it more likely in one school than the other to come out and practice a certain way? Probably. But in this study, interestingly, there was no statistical association between how the doctor approached maintenance care and not only their educational institution, but also their gender, age and number of years in practice, which was interesting. So what they discovered was again, about 25% of the study sample size was recommended continued care, and that was independent of how many factors were present. So factors could have been previous neck pain episodes, long duration of pain, initial improvement, and then those chiropractic characteristics, gender, age of the chiropractor, themselves, country of education. So 25% were recommended continued care regardless of what was going on. Now, 39% were recommended continued care when at least three indicators were checked, so to speak. Previous neck pain, long duration improvement after four weeks. That percentage recommended continued care dropped to 25% when two indicators of that were present and dropped to only 10% when one indicator was present, which is really, really interesting. So they discovered when they took all of this, put it into the data analyses and said, okay, what does this tell us? This, they found that having a long duration of current neck pain was the only clinical indicator that actually predicted if continued care was recommended to the patient by the chiropractor. And their findings indicate that clinical indicators for recommending Chiropractic care to patients with neck pain are different than those used recommending continued care for low back pain. In low back pain, we've normally seen that it is all about previous episodes as being the primary indicator. So with low back pain they see chiropractors recommending maintenance care specifically. Most likely, if the patient had previous episodes of low back pain. Now those could have been multiple short episodes, but multiple previous episodes. With neck pain, it was recommended more often when patients had a long duration of pain, even if that was their first episode. So that was interesting in the studies with low back showcased actually that duration had no statistical association with the care recommendation of maintenance care. So it's a really interesting, I think of these like an X or like a graph where one line crosses the other. It's really interesting how these two factors between the cervical spine and lumbar spine, the neck and the low back really play a completely different story out in terms of the recommendations. One relative neck pain relative to duration and low back pain relative to number of episodes. Now, we all know that maintenance care, it's designed to prevent future pain episodes and to improve function long term. So as they say in the study, it's logical that patients with a long duration of pain and or previous episodes may be recommended continued care based upon both of those factors, the fact that they've either had a lot of previous episodes or they've been in pain a long time. They also highlight the fact that some of us even subconsciously might be considering a biopsychosocial model, which is really, really important, contributing the development of persistent pain. We know a thick percentage of individuals with acute pain go into chronic pain. You've probably heard me talk about fear, avoidance behavior and that sensitization not only at the tissue level, but in the mind becoming super sensitive and fearful about moving. This all ties in to me to, to the biopsychosocial model. So keeping people moving quite literally segmentally with an adjustment, obviously regional and whole body with the instruction and or exercise you're providing either in office or at home is a really, really big factor. And they say, for instance, studies have shown patients with less favorable psychological profiles with better outcomes from a maintenance care approach. So if somebody does have, I'll kind of translate that. For patients that do have aggressive, maybe they're depressed, maybe they have fear, avoidance behavior. They have these factors psychologically that might limit their improvement. High, super high stress levels. It's been shown previously that maintenance care is a really good idea, especially for those individuals and they have better outcomes on the back end. Why? Probably because there's some accountability and coaching along the way. When you're going in and receiving the care, you're speaking with somebody about what's going on, you're seeing that you might be able to move a little bit more than you think, think you can safely and effectively, and you get that encouragement and you just have that accountability that is such a key component that I think is overlooked often in practices. You know, people kind of come in for results and they stay for accountability. As a friend of mine once said, and it's a hundred percent true, accountability is a really big thing. And when somebody's going into your practice over a period of time and you're doing movement assessments, maybe you're going through exercise, maybe you are, you know, adjusting, checking, you're using motion palpation, whatever it might be that you're approaching in your practice, it forces them to confront what's going on, to have a conversation about it. And often that's a really good thing. And us as chiropractors are really some of the perfect providers to initiate that care, to understand what the patient's dealing with and also to help them non pharmacologically, non surgically, and with one of the most powerful treatments ever developed, which is an adjustment or a manipulation. So the conclusion on this study was only 39% of patients presenting with previous neck pain episodes had been recommended continued care, but it depended upon those factors. And the primary factor was the duration of pain as opposed to the low back, the episode number and the number of episodes that they previous experienced. So I think this is a really, really interesting study. I thought it was really cool how they highlighted the differences between the lumbar spine and the cervical spine. I also just think there's some things hopefully that we touched on today's episode that gets you to step back and think about how you're approaching maintenance care in your practice. How are you thinking about it? When do you recommend it, how do you recommend it? And do you have differences between how you recommend it, between people with neck pain issues and lower back issues? All interesting points, all take home messages on today's episode. Before we wrap up, I wanna say a few words about chiro matchmakers. If you are looking for help in your practice and you're looking for it on a budget, check out a virtual ca. If you are looking for outbound calls, social media management, short form, video editing, insurance verification, all of that can be outsourced to a virtual CA for pennies on the dollar. So if you have not explored this. Maybe you're a lone wolf and you're not ready to hire that full time person yet. A virtual CA is a great way to get tasks off of your plate, get things done and free up your time to see more patients. Maybe you are a big practice and you already have a lot of people on staff, but you still have things falling through the cracks and using a virtual CA is a great way to absolutely solve those challenges. You can schedule a quick call with the team over at chiro matchmakers@www.cairo matchmakers.com. i have a virtual CA through ChiroMatchmakers. Helps me out tremendously and helps me be far more productive at a super affordable price point. So you can head over and have that conversation@chiromatchmakers.com otherwise. Thank you for being a chiropractor. Thank you for listening to this podcast. If you've not left a rating or review, I would love it if you took a moment to do so. Have a fantastic week in practice and I will talk to you.

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