10 Research in Action: Promoting Your Practice and the Profession
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Dynamic Chiropractic – May 1, 2019, Vol. 37, Issue 05

Research in Action: Promoting Your Practice and the Profession

By Ronald Feise, DC

There has never been a better time to be a chiropractor – especially an evidence-based chiropractor. In the past several years, a preponderance of positive research supporting the benefits and safety of the chiropractic package of treatment has emerged.

Simultaneously, research has highlighted the lack of benefits and increasing harms of the most common interventions used by U.S. medical doctors to treat nonspecific neck and back pain.

This creates an enormous opportunity for evidence-based chiropractors. Our national and state organizations and chiropractic colleges are doing their very best to promote chiropractic with their limited resources. But individual practitioners need to step up and lead the cause. Yes, we need to actively support our institutions. But we also need to take charge of our own practices and take steps to positively influence our communities.

Share Health Tips

Our individual practices can become tipping points of change. Current research can utterly transform our practices while enhancing our reputation in our communities. The key to unlocking these changes is for us spread the word about current research.

An effective way to do this is to share with patients one brief research synopsis per week in the form of a current, evidence-based "health tip." The health tip should be concise and easy to understand. For example, "A scientific review published in the Journal of the American Medical Association found that spinal manipulation was effective in patients with acute low back pain for improvements in pain and function, and found no serious harms.1 That is a strong endorsement from the top medical journal."1

The manner in which you deliver this communication is critically important. If you want to have a positive influence on your patients, you must show them you care. If they do not know you care, they will not care what you know.

Patients have clear expectations of their doctors. They expect you to be professional and caring, to deliver good results, and to be "up-to-date." Your weekly evidence-based health tip will ensure you not only meet these expectations, but also exceed them. Note that patients prefer to receive health tips not via a paper handout or email, but by verbal communication from their doctor or chiropractic team member.2

Hold 1-Minute Team Huddles

RESEARCH-BASED HEALTH TIPS: A FEW MORE EXAMPLES TO SHARE WITH YOUR PATIENTS
  • “Medical researchers found that one year after low back pain surgery, recurrence of the pain occurred in 29 percent of the patients, and that skyrocketed to 65 percent at three years.3 It can now be strongly recommend that spinal surgery should be avoided.”
  • “A study published in the Annals of Internal Medicine found that steroid spinal injection reduced low back pain at one month, but not at three months, six months and 12 months.4 Moreover, each steroid injection increases the risk of spinal fracture by 21 percent.5 This treatment gives you temporary pain relief with serious side effects and should not be used.”
  • “A study published in the Journal of the American Medical Association found that opioids failed to provide better pain relief than acetaminophen or NSAIDs at any follow-up period.6 Considering the addiction and death rates and treatment failure opioids must be avoided.”
  • “Research has found that 150 minutes of exercise per week reduces the risk for dementia and Alzheimer’s.7-8 If you are not already meeting this standard, I want you to start.”
For the greatest impact, you should engage your entire practice team in the process of sharing current research information with patients. An effective method to accomplish this is to use weekly 1-minute standing team huddles. These Monday-morning meetings with your team accomplish big results in just 60 seconds. These team huddles contribute to a spirit of community whereby the whole becomes greater than the sum of the parts. The role of leadership in creating this spirit is to acknowledge and respect the contributions of each team member to the success of the clinic.

In your 1-minute team huddle, you will first say a positive comment about how one of the team functions can positively affect patient outcomes and satisfaction. For example, "When you interact with any patient with warmth and compassion, you help create patient satisfaction. Your thoughtful communications are valuable to our patients. Thank you for your contributions! "

This demonstrates to the team members that you recognize their value. It elevates morale within the practice and motivates excellent team members to continue their employment with your clinic long-term.

After your positive comment, share the health tip of the week with your team. This ensures you and your team are on the same page. Knowing you care about them, the team is now ready to extend that same level of caring to your patients.

Communicate With MDs

In our communities, we need to be proactive in meeting and communicating with local medical providers. You should focus on internal medicine and general practitioners. These MDs are desperate to find alternatives to opioids for their neck and back pain patients. They are very receptive to evidence-based chiropractors who can share with them the best research of the day and provide research-based alternatives.

The opioid crisis has provided our profession with a rare and precious opportunity – a wide-open door to collaborate with our medical colleagues in solving an urgent, major health care issue.

An Opportunity We Can't Ignore

As chiropractors, we are in a unique position to inform our patients, inspire our teams, and highlight our profession's ability to provide safer, more effective treatment for neck and back pain. Armed with evidence, each of us can take the following steps to positively influence our practices and our communities: 1) support our national and state associations and colleges; 2) provide weekly evidence-based health tips to patients; 3) start every Monday morning with a 1-minute standing team huddle; and 4) provide local MDs with current research about our effectiveness and safety.

References

  1. Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA, 2017;317:1451-1460.
  2. Feise RJ. Cross-sectional study of patients' expectations using chiropractic care. Institute of Evidence-Based Chiropractic. 2019 March.
  3. Suri P, Pearson AM, Zhao W, et al. Pain recurrence after discectomy for symptomatic lumbar disc herniation. Spine, 2017;42:755-763.
  4. Nguyen C, Boutron I, Baron G, et al. Intradiscal glucocorticoid injection for patients with chronic low back pain associated with active discopathy: a randomized trial. Ann Intern Med, 2017;166:547-556.
  5. Mandel S, Schilling J, Peterson E, et al. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg (U.S.), 2013;95:961-4.
  6. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE Randomized Clinical Trial. JAMA, 2018;319:872-882.
  7. Head D, Bugg JM, Goate AM, et al. Exercise engagement as a moderator of the effects of APOE genotype on amyloid deposition. Arch Neurol, 2012 May 9;69(5) 636-643.
  8. Liu R, Sui X, Laditka JN, et al. Cardiorespiratory fitness as a predictor of dementia mortality in men and women. Med Sci Sports Exerc, 2012;44:253-9.

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