Brockport chiropractor on: “Seeking Evidence-Based Healthcare.” Part 1

Feb. 9, 2010 - PRLog -- Evidence-based healthcare (EBHC) can superficially sound like it needs no explanation, but a consumer shopping for healthcare should be knowledgeable on this term, and know how it will ultimately effect their treatment. The three main components of EBHC are implemented by considering current research (best evidence), clinical experience, and patient values when evaluating and managing a patient. This article will explain the first of the three EBHC parameters, and how clinicians use it to dictate treatment and imaging decisions that affect your care.

How to incorporate current research into treatment can be a touchy and sometimes extremely controversial subject. This was seen when the new guidelines for mammography screenings were released a few months ago. Physicians and patients were in an uproar about the new guidelines, which were quickly pulled back due to the outrage. Fortunately, in musculoskeletal care where life threatening pathologies are the minority cause of back pain, debate is usually between colleagues and rarely in the eye of the media. This is not to downplay the role of research in back pain treatment. Considering the recently increased economic toll of $86 billion, low back pain evaluation and management is heavily researched [1]. Recently published articles [2,3,4,5] have shown that clinicians can identify patients that are likely to receive almost immediate improvement of pain from spinal manipulation. For example, duration and location of symptoms, or a simple score on a questionnaire can actually predict whether or not patient’s symptoms will improve from spinal manipulation. The “clinical prediction rules” however do not come without short-comings. The clusters of patients identified are certainly not the only ones that will receive benefits from spinal manipulation. This would be argued by any practitioner whether chiropractor, physical therapist, or other professional that uses manipulation as a treatment option.

When evaluating a patient, I will consider many factors when deciding whether a patient is actually a candidate for spinal manipulation. One factor will be if the patient fits the mold for immediate response to treatment. If not, clinical experience may still direct me toward manipulation; if I feel the benefits still heavily outweigh the risks. I will consider any evidence on whether or not a patient is a candidate for another form of treatment such as lumbar flexion/distraction, end range loading, or simple exercises to be performed at home. Overall, clinical experience incorporated with the best available evidence will guide my treatment recommendation for every patient. Ignoring or not reading current research may be evident when a practitioner attempts to fit each patient’s condition into the treatment they offer. Certainly cardiovascular issues like hypertension, hyperlipidemia, or peripheral artery disease are not likely to respond to the same treatment. Much the same, not all back pain should be managed with the same treatment approach. That is why many chiropractors offer multiple conservative treatment options for their patients.

One way to screen a chiropractor on how up-to-date they are with current guidelines is by inquiring about the frequency of x-rays taken in their office. If your initial visit to a chiropractic office automatically includes x-rays to look for so-called “spinal misalignments,” chances are the provider is not using the latest guidelines for imaging. If x-rays are recommended, ask how the images will effect treatment options, and just what exactly are they looking for? Ordering an x-ray because it is part of a new patient intake is not an appropriate reason to expose a patient to radiation. Be wary of these situations.  A few of the current recommended guidelines for  plain film x-ray require a history of major trauma, minor trauma when patient is over 70 years of age, or the presence of “red flags” (disease pathology). Low back pain with sciatica of non-traumatic onset does not require x-rays unless the patient failed to respond to 4-6 weeks of care or if surgical intervention was being considered [6].

Aside from asking technical questions about your care, sizing up your provider should give you sufficient feedback. If you feel like you have to be sold on a treatment or you notice a lot of gimmick advertising to lure in patients, chances are the provider is treating patients to benefit their pocketbook as oppose to benefiting you, the consumer.

For more information on Joseph Butler visit the Rochester Chiropractic Group’s Brockport office at www.BrockportRCG.com

Reference:
1.Martin BI et al. 2008. Expenditures and health status among adults with back and neck problems. JAMA 299: 656-64.
2.Childs JD et al. 2004. A clinical prediction rule to identify patient s with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern med 141:920-928.
3.Fritz JM et al. 2005. Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following brief spinal manipulation intervention. BMC family practice. 6:29
4.Tseng YL et al. 2006. Predictors for the immediate responders to cervical manipulation in patients with neck pain. Man Ther 11:306-15.
5.Cleland JA et al. 2007. Development of a clinical prediction rule for guiding treatment of a subgroup of paitents with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther 87:9-23.
6.Bussieres AE et al. 2008. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. JMPT (31)1: 33-88.