Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study
Title Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study A ChiroSecure Research Update Abstract To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel. Discussion LBP is common, costly, and a significant cause of long-term sick leave and work loss. Many different interventions are available, but there exists no consensus on the best approach. One intervention often used is manipulative therapy. Current evidence from randomized controlled trials demonstrates that manipulative therapy may be as effective as other conservative treatments of LBP, but its appropriate role in the healthcare delivery system has not been established. Prospective, 2-arm randomized controlled trial pilot study comparing SMC plus CMT with only SMC. The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS). Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 ( P < 0.001) and week 4 ( P = 0.004). Mean numerical rating scale pain scores were also significantly better in the group that received CMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 ( P < 0.001) and week 4 ( P = 0.004). The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP. Reference Goertz, Christine M., DC, PhD*; Long, Cynthia R., PhD*; Hondras, Maria A., DC, MPH*; Petri, Richard, MD†; Delgado, Roxana, MS‡; Lawrence, Dana J., DC, MMedEd, MA§; Owens, Edward F., MS, DC¶; Meeker, William C., DC, MPH. Spine: April 15, 2013 – Volume 38 – Issue 8 – p 627-634. https://journals.lww.com/spinejournal/Abstract/2013/04150
Blood pressure changes in African American patients receiving chiropractic care in a teaching clinic: a preliminary study
A ChiroSecure Research Update Abstract The purpose of this preliminary study was to determine if a course of chiropractic care would change blood pressure measurements in African American patients and to determine if a study was feasible in a chiropractic teaching clinic. Discussion Twenty-four African American patients received chiropractic care in a chiropractic teaching clinic over a study period that spanned 23 visits for each patient. Inclusion criteria consisted of patients having a diagnosis of prehypertension (120-139/80-89) or hypertension stage 1 (140-159/90-99). The mean values of 3 baseline blood pressure readings were compared with the mean values of blood pressure readings taken on visits 21, 22, and 23. This study showed that research of this nature may be feasible in chiropractic teaching clinics. The preliminary findings of this study showed that, for a subgroup of African American patients receiving chiropractic care, blood pressure decreased for (a) hypertension stage 1 patients and (b) the sample when those with excessive body mass index were excluded. Reference McMasters KL, Wang J, York J, Hart J, Neely C, Delain RJ. Blood pressure changes in African American patients receiving chiropractic care in a teaching clinic: a preliminary study. J Chiropr Med. 2013;12(2):55–59. doi:10.1016/j.jcm.2013.06.002. https://www.ncbi.nlm.nih.gov/pubmed/24294146
Outcomes of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment
A ChiroSecure Research Update Outcomes of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment Abstract The purpose of an outcome study of pregnant patients with low back or pelvic pain undergoing chiropractic was 1) to report outcomes in receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome. Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded. Low back (LBP) and pelvic pain in pregnant women is such a common phenomenon, affecting 50-80%, that it is often considered a normal part of the pregnancy. Discussion Out of the 115 recruited pregnant patients, 52% ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There is clinical evidence that proves most pregnant patients undergoing chiropractic treatment reported relevant improvement at all time points up to 1 year. No serious adverse events were reported in this study and over 85% of the patients were happy or very happy with their chiropractic treatment. Adverse events from spinal manipulation to pregnant women or those in the early post-partum period are very rare with only 7 cases found in the literature. The impact that LBP or pelvic pain may have on quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners. Reference Peterson, C.K., Mühlemann, D. & Humphreys, B.K. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropr Man Therap 22, 15 (2014). https://doi.org/10.1186/2045-709X-22-15
Three most common people problems
Hey everyone. Dr Brian Capra here from Genesis Chiropractic Software with another episode. Today I want to talk to you about the three most common types of people problems. And I mean, by people I mean your team, and when I mean problems, the things that cause them or prevent them from performing to their fullest level and serving the function in your office and your business. Number one is a training issue. So we talked about recently, people process technology. We talked about how the technology should, especially with Genesis, would show you by the end of the day how many tasks, or during the day, how many tasks each person in your office would have to perform. And then by the end of the day you’d know what was left, if anything, which there shouldn’t be anything. But what if there was something left over that wasn’t completed before the end of the day? It’s an easy conversation. It’s proactive, you’re proactively managing the patient experience. So now you go on there and you go to your team member and you say, “what happened? There’s 10 of these tasks left over.” And you look at them, let’s say they’re all 10 are no shows. You might be concerned, you might say, “Hey, you know what? Why haven’t you followed up on all these things?” And they may say to you, “well I just started on Tuesday and I don’t know how to do that one thing.” So there you have a training issue and they just need better training, but at least you were proactive about it. All right, so that’s a simple one. Training issue. Second example, the second most common problem is a capacity issue. Capacity is very simple. “There’s 10 things leftover. What happened? How could I help you with these 10 things that are left over?” “Well I did 50 and those are just the 10 that are remaining.” So now we can see that they are just purely out of their capacity to be able to do that amount of work for that simple problem in the practice. So now they go in and you say, okay, we may need more team members, we may need to automate certain things. Maybe if we turned on text reminders and appointment reminders and emails and things like that, maybe that would decrease the need for how many no shows are happening in the practice. Maybe you see a 2000 patients a week and there’s only 10 left at the end of the day, yet you still have a capacity issue. So you can automate in those cases or sometimes you really just need another person. The third type of thing that can happen, pretty simple is a wrong seat, wrong law office type of problem. So in that case, you have a situation where you go to that person and you say, “how come you haven’t called all the no-shows or how come all these re exams didn’t get scheduled today?” Or whatever the case may be, they may say to you, “you know, I really, really hate doing that thing, that type of task, I hate doing it. It’s too confrontational for me. What I’d rather do is call companies and follow up on insurance claims or handle care plans or financials or whatever.” So in that case, you have a great person on your team that wants to work real hard, but they’re just in the wrong seat in your practice, meaning the wrong role in your business. And so you have a good person in the wrong seat. So that’s a wrong seat problem. Now, the wrong practice, wrong business problem. Now you have a real problem. So this should be mitigated by some of your upfront hiring protocols, how you hire people, how you find people, how you find people to apply for your office, your application process. I definitely recommend you work with Chiro Matchmakers if you’re a chiropractic office. It’s a staffing company for Chiropractic offices, they do a lot of profiling, making sure you’re hiring the right person for the role you’re looking for. But if you get somebody in your office that understands the mission of your business, your why behind your business, your core values in your business, and you hire them for a certain role and then they tell you they hate it, it could happen. It does happen. They’re just in the wrong seat or the wrong business, They’re working for the wrong type of business. Now, what’s great about technology with Genesis, since you know right there and then, the day that there’s too many tasks that are left over, and as soon as you confront the person about that, and it’s not confrontational necessarily, but you’re going to approach it in a proactive way and say, “how can I help you with that thing?” And they tell you, “you know what, I hate doing that thing and I never am gonna like it. And I hate this.” Basically, it’ll come up pretty quickly. You’ll figure out, you might shift them into a different role and they don’t perform there either. So then you have the wrong person in the wrong business. So we talked about there’s three types of common issues with staff, with people in your practice, your business. One is training, two is capacity and three, wrong seat or wrong business. So this pretty simple short video I definitely, to prevent, the capacity and the training issues are easy. Even the wrong seat is relatively easy. Preventing hiring the wrong person, that’s a bigger problem. You want to make sure you have really good hiring processes. I definitely recommend you work with Chiro Matchmakers to make sure you get the right person for your business, before you find the right seat for them. Okay. Thanks so much. Have a great weekend. I’ll talk to you soon.
