Why Older Adults with Low Back Pain Choose (or Don’t Choose) Chiropractic | Podcast Ep. 384

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are back with research and a really fantastic paper that was just released. I'm going to drop the link down in the episode show notes but this is all about the perceived barriers and facilitators for chiropractic care in older adults with low back pain. This is insights from a qualitative exploration in a Dutch context. A lot of great information to understand why people do choose chiropractic, why people might not choose chiropractic. And this can directly inform your messaging, your marketing, your communications so that you can proactively address these concerns and and make the patient's life better and make as a business owner your life a heck of a lot easier as well. Now before we dive in, I wanna say a few words about the smart chiropractor. If you would like to pick up and accelerate your reactivations this year, head over to thesmartchiropractor.com and book a patient pilot demo for every 100 people on your email list on average. Our Average member has 2.6 reactivations per month per 100 people on their email list. So we have a 3x ROI guarantee. We'll hook you up with a whole bunch of bonuses as well to make it super easy. And everything is month to month. So if you would like to generate more reactivations, if you have an email list of over 300 people you're listening to this, please head over and do a demo because we can help you maximize the money is in your list. We can help you maximize reactivations on your list utilizing great teacher and invite content that's all research based. Now as I said at the top on today's episode, we're talking all about perceived barriers and facilities facilitators for chiropractic care in older adults with low back pain. So the Netherlands Dutch population, no different in many ways than the US population and many other populations, which is it has an aging population and these figures are only gonna increase in the coming years. So there's a lot of people getting older and compared to younger people, low back pain can have a disproportionate effect on older adults. Why? Well, decreased mobility, limited social participation, greater chances of isolation, reduced perceived quality of life amongst a host of other things. If you have been on the planet for five decades, six decades plus, gravity takes its toll. Gravity is undefeated over time. Gravity, posture, previous injuries, all of these things add up as we age and many, many Many, many, many older people struggle with lumbar spine issues. Now, in the Netherlands, the professional chiropractic is pretty small, so less than 600 total chiropractors in a country with more than 17 million people. But even with that such small amount of chiropractors, in 2019, more than 1 million visits or treatments were delivered by chiropractors in the Netherlands. So there is no shortage, I'm going to say, of opportunity. I know it's easy to say and harder to implement, but there's no shortage of opportunity. There is so many people out there that need our help. It really comes down to why we talk so much about the evidence based chiropractor with B2B referrals, getting referrals from other healthcare providers, and also the smart chiropractor and patient pilot with B2C Communications, because it's all communication. Marketing is communication. You don't need to discount your services. There's such an array of opportunity people are searching for what we do. We'll dive into some of the reasons why, of course, on today's episode, so why we've studied so much and we highlight this week in and week out in this podcast of what are the effects of chiropractic care, what are the mechanisms of action. But there's actually not that much known as far as what motivates people to seek care. And this is critically important. So many people, here's an interesting fact, many people with low back pain do not seek care from a healthcare professional for their complaints. So what does that mean? It means there's opportunity. But when we talk about 80 to 90% of people experiencing low back pain in their life and that there is so much opportunity, many of these individuals are just struggling silently and they don't know how to make a great decision. So that's a really, really important thing. And some factors that influence whether people seek care is the intensity and disability of the pain. Of course, fear of job impairment, involvement in sports, age and income were all determinant and education levels were determinants to influence the behavior to seek care. So I'm gonna throw one more thing out there that you know, that sentence is, I think, true and they have it cited here. But I'm just gonna get pragmatic with it. And outside of the research language, people seek care because their quality of life has changed. People will live with pain forever. But once the quality of life, I think of it like a dial, so to speak. Once that trips over, it's different for everybody. But once it trips Over a certain amount of unable to do something. That is when people seek care. And for some people, that's like, when pain hits, they're like, I can't do what I wanna do. I'm heading in seeing a chiropractor, seeing somebody else. Other people, as we all know, they'll live with pain for decades. And then it's like, well, what made you come in today? Well, last week I was unable to do this, or it just added up. It just hit that threshold point. That threshold's different for everybody. But it's really, really important to keep that in mind. And specifically, older adults are less likely to seek care for low back pain due to an assumption that low back pain is a, quote, unquote, normal part of aging. And older people also tend to display and negative attitude towards pharmacological or surgical interventions, and they deem low back pain as less important than other comorbidities. So a couple of things there to unpack. One is a negative attitude towards pharmacological or surgical interventions is a really good thing. They're not running to get surgery to, quote, unquote, fix the problem. Which 99% of the time, somebody that practiced in multiple orthopedic groups does not fix the problem. Let's be super, super clear about that. Very rarely is that the case. So that's a good thing that we can, I'm gonna say, positively take advantage of is that many older adults aren't looking to stack on medications, they're not looking for surgical interventions. They're really just looking for improved quality of life. And that is something we can deliver, but we have to be able to accurately communicate that. So older adults also might have more fear of spinal manipulation or adjustments, which in turn can be less for the treatment of low back pain than the neck. So cervical spine, always a concern. If somebody has heard myth, conjecture, they've never got adjusted. That can be something that's, oh, I don't know, right? That fear of the unknown is a real thing. And I believe that is something that we need to address head on. So this study was really put out there to identify the factors and specifically those barriers and facilitators to people seeking care for low back pain, particularly older adults and with their experience with chiropractic specifically. So the inclusion criteria for the study were people over 55 years of age that were struggling with low back pain with or without radiculopathy. They were invited to participate. Anybody who had previously visited a chiropractor was excluded because they really wanted to identify what are those again, barriers or facilitators towards the initial decision making process. So not once they had a great experience, they went back. That's wonderful. But once what really got them over the hump or prevented them from making that initial decision to see a chiropractor. And this study was done in two stages, which I think is really wise. Stage one had a semi structured interview with the people struggling with low back pain for between February 2021 and September 2021. So this actually got to production pretty quickly. Less than this came out this past month. So less than two years. Getting to production on a study is pretty darn good. Now as a continuation, they also had focus group interviews in May 2022. So that was the second stage there. So two stages of interviews. Ultimately really trying to identify, all right, what helped you make that decision. You're struggling with low back pain, how are you thinking about the decision making? And then the focus group afterward to really hone in on the decision making characteristics. So most interestingly, most people in this study had previously contacted other therapists directly and that was interesting. So they might have seen a physiotherapist, an acupuncturist, an osteopath, manual therapist, et cetera. That was very, very interesting to me. Or they may have been referred by the gp, that general provider, or as we'd say in the States, a family doctor. So four factors ultimately were found to influence. This is really the meat of this study. Four factors were found to influence the care seeking behavior of the people in this study. And they were one, generic aspects. We'll tell you what that means in a moment. Two, financial, three, expectations and four, image of a chiropractor. So this is. These are really, really important. This is where the rubber meets the road. These are areas that I'm going to say in your marketing and communications, whether you're shooting video, whether you're sending emails, whatever you might be doing to get out there in your. These are things you want to address head on because they are the four major factors that influence care seeking behavior. So let's dive in. Number one was generic aspects to seeking care. So there's just some things that quite frankly have nothing to do with chiropractic but are real, which is one, proximity to a practice, waiting time. Right. These things aren't isolated to chiropractic, but they're a real thing. In addition, a low back pain sufferers in this group saw the ineffectiveness of other therapies as a major facilitator. So lack of benefit from an earlier treatment was a motivator to search elsewhere. So let's tie in a few things here. One is proximity to the practice and wait time. Wait time is something you can control. So let's be super, super clear about that. Having great systems and processes in your practice decrease wait time. That is a facilitator. You want to have timeliness, you want to have convenience. Now proximity to the practice a little bit more difficult. However, in your messaging you can highlight ease of parking, ease to the highway, ease to insert whatever is nice and convenient around your practice in your town. The convenience of proximity doesn't necessarily mean somebody needs to live across the street. But is it easy to get to? Because something could be two miles away, but you know, over a river, under a bridge, you know, you haven't take a ferry to get there. That's inconvenient. Something could be 8 miles away, 10 miles away, but it's directly off of the highway and that makes it so easy to get there. So think about proximity in terms of convenience in your messaging. Furthermore, ineffectiveness of other therapies. Have you struggled with, have you hit a dead end? These are important messaging techniques that you can utilize because it is a major factor in people seeking care. Hey, I failed care elsewhere and I'm still looking for something. So being able to message that appropriately is really important. We've helped thousands of people that hit a dead end with blank. Right? That's important. Number two is financial. So a lot of participants in this study stated that treatments, they were concerned about the expense of treatment because they were on like a state pension. Now others said they wouldn't think twice or you know, wouldn't have gone if a chiropractor wasn't reimbursed. Some didn't care about reimbursement, so it's a little bit all over the place. But my take home message here is being able to accurately describe the financial components of what you do is really, really important. Now let me be super clear about that. I don't mean come on in for $19, we'll give you X rays in the kitchen sink. I just, I don't like that advertising. I don't think it's necessary. I don't think it positions well long term. There's nothing about it I like. However, I do think it's really, really the irony is people put out those advertisements and then if somebody calls and you're just asking a question, I've got this. I'll take it out of chiropractic with Dentists all the time. It's like you call and it's like, how much is it to have my teeth cleaned? How much is it to get an adjustment? And it's like, well, you know, if it's Tuesday and you have this, it's like, whoa, this is way too complex. How so? Make it super clear. Hey, an office visit in our practice is X and an examination is Y. Right? The more clear you can be with that, the more easy to understand your fee structure is for people. And the more, the less that there's complicating factors, the easier it is for a decision making process. Quite frankly, this, this is not exclusive to healthcare as well. Whether you're buying a tv, a blender or anything else, if you can't figure out how you're gonna pay for something or what the exact price is, it's horrible. So take a look at your fee structure and make sure it's like super clear to understand. Because if it's not, I can assure you it's doing your practice a disservice. Number three is expectations. And the most common reported facilitator was the possibility of improvement. And that's important to keep. It wasn't the promise of improvement, it was the possibility of improvement. So is your messaging inspiring people to take action? And participants also expected a holistic approach from their chiropractor rather than focusing solely on the low back. That's also really important information. Is your messaging getting out there highlighting the fact that you take a holistic view of the body, that you are a movement based healthcare professional, that you are going to look and discover and uncover things, that quite frankly, when they go in and have a two minute meeting with their primary care doctor. I don't mean to dog primary care doctors here, but you know, sitting in primary care doctors are not a good place to go for neuromusculoskeletal care. 99% of the time it's a two minute office visit. Practically no physical exam. And what they refer to is terrible. You know, medications, advanced imaging, very early on, you know, a surgeon right off the bat, pain management doctors, don't get me started. So you can really overcome that by doing a great job emphasizing the fact that, that you spend time, that you analyze movement, that you take a look at the person as a whole. And that doesn't mean you need to do a four hour long or a one hour long examination. It doesn't tie to time. But what it does tie to is comprehensiveness. So really highlighting that super important. And number four, was image of the chiropractor awareness. And that's what this really came down to. They didn't know what a chiropractor did or what conditions they take care of. Are you putting out clear information around this? This is something I talked about literally last night on a master class for reactivations that we did for the smart chiropractor. And the example is this. It's super clean, it's super easy, we've all experienced it. Patient comes in with low back pain, they have a great experience in your practice. You don't see them for a year or two. They come back a year or two later and they're like, ah, my low back was bugging me. I knew I needed to come back in. You're like, awesome, great to see you. Let's get you back and take care of things. And as you're talking to them, they're like, you know, last year like I had a shoulder and a neck issue and. But I know you're like the low back doctor, so I went somewhere else for that. And you're like, what? What's going on? That happens all the time. And it is a communication issue. And quite frankly, I'll just be super clear. If you're not sending a weekly email newsletter via Patient Pilot to generate reactivations to stay top of mind and to proactively address the questions people have about their health, you're just blowing it. You're blowing it from a business sense because huge missed opportunity there. And you're also blowing it from a patient communication and patient engagement and patient centric care way because they don't know how to make the selection. And if you're trying to tell them everything they need to know during the office visit in your practice, it's just impossible. You have to have systems and processes that communicate outside of that. And email is the best way to do it. Text is great for missed appointment reminders, super short messages, transactional by nature. But emails where you can tell stories, where you can build relationship and where you can truly teach and invite, which is critically, critically important. So this was really eye opening to me. I hope it is to you as well. Most of the people in this study did some research on chiropractic care also before making their appointment. So they looked at websites, they checked out associations. They say, so you know, take a look at your website, you know, make sure that you have great information out there that highlights who you are and what you do and makes it easy for somebody to make a decision. I know it sounds like so basic. But but I can tell you like 75% of chiropractic websites in my mind when I check them out I'm like this is hard. Like I don't understand what's going on. Like it's not patient centric. It's hard to see exactly what this doc does. Like do they do everything? I don't. It's like it's or features focused instead of benefit focused conversation for a different podcast. But important to take a look at with your marketing and communications because ultimately it's going to make a huge difference in in your ability to take care and help people and grow your business and scale your business. So the conclusion in this study was older adults are often unaware of the possibility of chiropractic care for their low back pain. However, this factor might not even be limited to this group. That is the bottom line with this. So it is all about communications and marketing. You notice I'm not saying paid advertising. This is about truly marketing, getting out there, telling your story in a way that connects with other people and inspires them to take action. I think that is something we all should be doing a better job of. Why do I say that? Because with 85%, 90% of people dealing with low back pain and our market penetration being 10% that Delta tells us there's a lot of room for growth. Now before we wrap up, I want to say a few things about Kiro Spring. Kyro Spring Awesome EHR company. You heard me have an interview just a couple of weeks back with Brian at Kairo Spring and I'm going to encourage you to check them out. See why they are voted the best solution for chiropractors by chiropractors. Chirospring.com offer to schedule a demo. Schedule a demo. They'll hook you up with a $50Amazon G gift card. If you're frustrated with your current EHR, get 50Amazon gift card and see if you can improve your position. Kairospring.com offer that will hook you up with a 50Amazon gift card. I will drop that link down in the show notes as well to make it super easy. Additionally, if you have not picked up your set or pair of orthotics from Power Step. Come on. They support this podcast. You should support them and they're going to hook you up with a free sample pair. These were designed by a podiatrist over 30 years ago. They're awesome. They're what I use, what my dad uses. Pro.powerstep.com sample use the code EBC for evidence based chiropractor EBC for evidence based Chiropractor I'll drop that link down below. And thank you so much for tuning in and making this the most listened to chiropractic podcast out there. If you have been listening, I would love to hear some feedback or a review. You can leave that directly on your phone, just kind of scroll on down, hit how many stars, leave a sentence or two. I would love to hear feedback from you. Thank you so much for being a chiropractor. Thank you for listening. Have an awesome week in practice and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.