Evidence based chiropractic care; Does a research based chiropractor guarantee a better outcome?
The recent buzzword in healthcare is evidence based. There have been many interventions that were considered both by the public and by the healthcare institutions to be medically essential practices that help save lives. The public bought into these ideas for years, only to recently find out that common themes such as the necessary PSA test, mammograms, breast exams to name a few were necessary and saved lives. We found out recently these procedures were resulting in more harm than good, however, those who believe their lives were saved feel differently. Basically, research over many years had shown these tests resulted in unnecessary procedures, surgeries and fear. While research is indeed important, one would question how we were as the general public talked into doing things that were bad for us, as fear was used to help people find their way into submission. Basically, evidence has changed the way doctors weigh their evidence and nothing is off the table.
Evidence based care is also affecting the chiropractic profession as well, as chiropractors are continuing to evolve into a profession which is rapidly gaining the trust of the public as well as the trust of many medical providers. For years, chiropractic was considered a fringe practice, as the profession itself did not adequately police itself, which would have controlled some fringe elements within the profession that often did more to harm all chiropractors professionally.
Today, chiropractors who want to be mainstream are evidence based, have continuing education requirements and have specialty councils. In our practice, we are certified internationally to treat sports injuries (ICCSP) which encompassed orthopedics, neurology, as well as kinesiology.
The profession has had to fight for inclusion in everything, because of the politics of who gets covered and who does not, and in todays funding environment, chiropractors, even though they have proved over and over that they are the most cost effective providers of musculoskeletal medicine, other professions with more cultural authority have often been treated better financially as well as professionally, regardless of their effectiveness. Most people who need to access the healthcare system are unaware that often professional bias is a determinant for referral rather than the concern for whom is most effective. The truth is, most medical providers have never stepped into today’s chiropractic office, unless they themselves found themselves having a problem that they could not resolve using the diagnostic tools they use on their patients. In our experience, when doctors themselves have a positive experience in a chiropractic office, a flood of referrals to the chiropractor follow.
While evidence based is important in the chiropractic office, the way the doctor diagnoses, takes your history and then finally treats you can make a huge difference in whether your problem resolves quickly and cost effectively. One of the newest methods many chiropractors are beginning to learn is active examination. There are a number of schools of thought including the functional movement screen, which shows weaknesses in the musculoskeletal system and gives a sort of cookbook method of strengthening those weaknesses with exercises. Our office developed a number of tests that reliably and quickly diagnoses and resolves many types of lower back, sciatic, neck, shoulder, ankle, knee and wrist and even elbow problems such as tennis elbow.
The reason this works better than the old model of naming it something such as bursitis and then throwing a protocol at it (such as is often seen in physical therapy) is that it requires the use of treat – test – treat, which has been scientifically shown to be a valid protocol to resolve many mechanical problems. It has proven itself to be more efficient than doing the same thing 6-10 times and then trying to figure out if it had a good effect. Instead, the health care provider tests, works on the region using a number of possible procedures that may include chiropractic manipulation, myofascial release treatment, exercise and instrument assisted soft tissue treatment. The patient is tested, treated and then tested again to see if the mechanical basis for the problem has improved during the visit, adding to the accuracy of the treatment to resolve the condition.
In the current healthcare climate, where patients are often finding that they now have large deductibles to meet, and they are paying for their care themselves, or with some assistance from their employer, many are looking for the best care on their own personal budget. Some people are finding that the doctor who charges the least during a visit also does the least, while other providers who are more comprehensive in their approach and may charge more since they do more, often resolve their problem in less time and more effectively, resulting in a lower cost overall for the care of their condition.
Research can often be confusing, since many studies often show manipulation vs. exercise, or chiropractic manipulation vs. physical therapy or vs. standard medical care. In the real world, your most knowledgeable healthcare providers often use manipulation, myofascial release, instrument assisted soft tissue methods as well as exercise, so having exercise vs. manipulation studies is often confining and does not truly show how the most effective providers actually practice and by using a number of different methods to fully rehabilitate a condition, the doctor is choosing the best procedures to get the best outcome.
Many providers are also now switching to electronic health records, something most patients have seen in their primary doctors offices, large multidisciplinary practices and hospitals for some time now. The benefit is the sharing of records between providers who have access to the system. The downside is that many patients are finding a doctor is now more fixated on their screen than on their problem. Many chiropractors are looking for systems that allow them to focus on the patient, rather than the notes, but at the same time, allowing to better quality and detailed notes than the current paper systems allow for. Most offices are likely to have some form of electronic notes later this year, since with the advent of ICD-10, the new coding system taking effect on October 1st, 2014, electronic notes are essential to eliminate interference by insurance carriers in patients and their care plans.
How to choose a chiropractor and get the best care for your investment.
1. Find an office that performs active evaluation and uses the treat – test – treat protocol.
2. Look for someone who performs Myofascial Release Treatment, ART (a style of myofascial release treatment).
3. Look for someone who gives you exercises as part of your treatment plan. Active treatment plans are always more effective vs. sedentary methods of years past that may consist of heat, muscle stim and other non active methods.
4. If you are a runner, find a practitioner who has a treadmill, since this can help quickly diagnose and resolve most running injuries.
5. Look for someone whose treatment plans are sensible. Most lower back problems should resolve in under 20 visits (unless there is a more severe disc problem at the root of the pain). Your doctor should be able to explain things in plain English to you in a way you can understand. Beware of doctors of any type of use hard to understand words or concepts, since most healthcare issues in the musculoskeletal system are relatively easy to understand.
For more information, explore our web site www.backfixer1.com.