Evidence-Based Chiropractic

Jeff Williams - evidence-based chiropractor

Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

August 12, 2021 chiropracticforward Back Pain, Chiropractic, Chiropractic Forward Podcast, Chronic Pain, Evidence Based Chiropractic, Evidence-Based Chiropractic, Evidence-based Chiropractor, Fibromyalgia, Obesity 00:18:58 0 Comments

CF 190: Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

Today we’re going to talk about obesity in youth and chronic pain, we’ll talk about fibromyalgia and hyperbaric oxygen chambers, and we’ll talk about chronic pain and the healing journey.  But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #190 Now if you missed last week’s episode , we were joined by the amazing Dr. Brett Winchester from the St. Louis area. This doctor is just phenomenal in everything he does and says and we are all fortunate to have him in this profession. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Day 1 of our nurse practitioner starting is today. This morning has, of course, had its hiccups. We have the EHR where we have him set up but he has to have his own login and password and all that good stuff so that’s been one challenge so far.  Just getting oriented with where all of the stuff is, lidocaine, lab tubes, swabs, blah blah blah. Still waiting on the autoclave and still getting the malpractice policy in place this morning. What a process that’s been.  But we knew there’d be hiccups, and we’re getting them addressed. Then I have my regular life to contend with. I have patients to treat and a podcast to write so here we go. Short and sweet on this one because my cup is running over this morning.  Item #1 Our first item today is called “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves” by Hainsworth et. al. (Keri R Hainsworth 2021) and published in Pain Medicine in June of 2021 and day-um…..that’s hot! Why They Did It The aim of this commentary is to review the current science on co-occurring chronic pain and obesity in children and adolescents. In so doing, we also highlight some of the current gaps in knowledge. It is our hope that this commentary will draw attention to an overlooked area of research and clinical endeavors within the field of pediatric pain. The authors note that it is becoming increasingly clear that we should be familiar with this research. Both chronic pain and obesity have been rising in children for some time and studies are showing that obesity exacerbates the negative outcomes associated with chronic pain.  In addition, accumulating research exists on all facets of the co-occurrence of chronic pain and obesity in adults. Given all this, the paucity of research in this area of pediatric chronic pain and obesity is at a minimum, disheartening, and at a maximum, unconscionable. Ooooweee! That’s like putting a white glove on and smacking some clown around the room a little bit, isn’t it? I like it. It give me a little tickle.  Here are their main points:
  • On average, it can take 2 years longer for youth with obesity to be referred to a pediatric pain clinic than it does for youth with a normal weight
  • Pediatric patients with CPO have health-related quality of life that is more impaired in every domain than patients with chronic pain and a healthy body mass index percentile
  • Although systemic inflammation is commonly elevated in youth with obesity, patients with CPO have significantly higher levels of systemic inflammation than those with chronic pain alone or obesity alone 
  • Children with CPO are at increased risk of being treated as though they bear more responsibility for their health (and by extension, their pain) than youth without obesity and are at increased risk of pain dismissal and biased medical care
  • CPO in children and adolescents is associated with more impaired physical functioning and lower levels of physical activity than youth with chronic pain alone or obesity alone Further, parents report that their children with CPO (particularly girls) have greater functional disability (one of the most important outcomes in our field) than parents of youth with chronic pain and a normal body mass index
  • While multidisciplinary pain management programs work well for patients with a healthy weight, this is not true for those with comorbid obesity. Patients with a healthy weight improve in functional disability within 3 months of intake, whereas patients with CPO stagnate
First, even though we as clinicians and researchers need to address obesity in the context of chronic pain, we must be extremely thoughtful about how we move forward. Weight is a very sensitive subject, therefore, the call for more research in this area must strongly consider the need for sensitivity. CPO is the co-occurrence of a typically “invisible,” debilitating condition coupled with a condition so visible that it is sadly associated with victimization from important people in the child’s life, including peers, parents, and teachers Second, we would do well to closely follow the admonitions and advice of our colleagues whose primary clinical and research focus is on obesity and stigma. Suggestions from these experts include first recognizing that weight bias exists even among pediatric health care providers [20]. Additionally, language must be very carefully considered. Puhl et al. [20] offer the practical and sensitive suggestion to ask the patient and family about preferred words or terms in discussions about weight-related health Third, like other health care professionals, we would benefit from a greater understanding of the complexity of obesity and the “potential benefits and disadvantages of introducing weight-management discussions with patients” [14](p865). Certainly, there will be times when weight-related discussions would be contraindicated by the patient’s and/or family’s psychological or emotional state. However, when weight needs to be raised in relation to a child’s chronic pain, it may be best received in the context of health implications. Obesity is a multifactorial disease with strong genetic contributions. It is also associated with systemic inflammation, metabolic syndrome, and increased risk for diabetes and cardiovascular disease, as well as chronic pain. In fact, most are unaware that obesity is a risk factor for migraines in pediatric populations. That said, weight-related health or weight-related pain discussions cannot focus entirely on losing weight. For many, it is a struggle to change their weight status, and even if it is possible, this process takes time. We must not ignore managing pain while we wait for possible weight reduction. CHIROUP ADVERTISEMENT Item #2 Our second one today is called “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia” by Curtis et. al.(K Curtis 2021)  and published in Pain Medicine in June of 2021…….pork chops and apple sauce.  Why They Did It To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM). How They Did It
  • A total of 17 patients completed the study
  • A cohort study with a delayed treatment arm used as a comparator.
  • Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada.
  • Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire.
  • Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period
  • HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks
  • Both groups were assessed at baseline, after HBOT intervention, and at 3 months’ follow-up.
What They Found
  • HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients
  • The efficacy of HBOT was evident in most of the outcomes in both groups
  • This improvement was sustained at 3-month follow-up assessment.
Wrap It Up HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment. I don’ tank about you but I’m not going to go out and buy an oxygen chamber this afternoon but, it’s interesting and I’ve always heard positive things about them so this one peaked my interest a bit. I figured it would with you as well.  Item #3 The last one is called “A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies” by Toye et. al. and also published in Pain Medicine in June of 2021….Smoke show!! You know, it’s almost like I got an email from Pain Medicine last week highlighting some of their newest research in their June edition. Weird how all of these articles were all in the same month and in the same episode here. Right? Why They Did It There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery. How They Did It
  • A synthesis of qualitative research using meta-ethnography.
  • We used the seven stages of meta-ethnography. 
  • We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. 
  • We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.
  • We screened 1,328 titles and included 195 studies.
Wrap It Up The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
  • K Curtis, P., J Katz, PhD, C Djaiani, BSc, G O’Leary, MD, FRCPC, J Uehling, MS, CCRP, J Carroll, BHA, D Santa Mina, PhD, H Clarke, MD, PhD, FRCPC, M Gofeld, MD, PhD, FRCPC, R Katznelson, MD, FRCPC, (2021). “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia.” Pain Med 22(6): 1324-1332.
  • Keri R Hainsworth, P., Monica L Gremillion, PhD, W Hobart Davies, PhD, Stacy C Stolzman, PT, MPT, PhD, Steven J Weisman, MD, (2021). “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves.” Pain Med 22(6): 1243-1245.
       
Dr. Bobby Maybee - Forward Thinking Chiropractic Alliance

w/ Dr. Bobby Maybee – Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration (Part One)

January 21, 2021 chiropracticforward Evidence-Based Chiropractic, Evidence-based Chiropractor, FTCA 00:50:51 0 Comments

CF 161: w/ Dr. Bobby Maybee – Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration (Part One)

Today we’re going to be joined by Dr. Bobby Maybee who is involved in so many things chiropractic but most notably he’s the leader of the Forward Thinking Chiropractic Alliance and co-founder of the Chiropractic Success Academy. This is going to be an excellent episode folks. Full of insight, instruction, and inspiration.  But first, here’s that sweet sweet bumper music.

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #161 Now if you missed last week’s episode , we talked about lumbar spinal fusion surgery. This was new, current, and very much in favor of conservative, non-pharmacological, nonsurgical care.. Keep up with the class.  On the personal end of things….. I’d like to hear how some of you are busier than normal or how some of you have only dropped off a bit during COVID. I wrapped up my stats from 2020 and it was a bit of a blood bath around my joint if I’m being honest and I’m always honest with you all. That’s they only way we move forward. Honesty.  So, let’s cover a few of the key stats. By the way, if you’re not keeping good stats and measuring all of your office metrics, I can’t tell you what a mistake it is that you’re making. My office turned around when I started accurately tracking my metrics. How can you know where you’re going or measure success in a quantifiable way if you’re not measuring it? As you’ll find out more and more in the coming months, I’m very big on keeping stats because it turned my office around. I know the value. Anyway, let’s get to some of my take-aways from my 2020 stats. 

  • One of the big kickers for me is that my new patients were down 36.1% from 2019. Yeah, that hurt like hell, folks. That’s in spite of picking up in our marketing efforts, posting and boosting about our cleaning and disinfecting efforts, and growing our social media following. Our area was hit hard with COVID. On the New York Times site, Amarillo, TX at different times and even recently has been #13 nationwide in areas hit the hardest. At one time, we were #2 on their list of the areas with the most new cases. People just did not feel comfortable going anywhere around here at different times during the year. Some times were more comfortable than others of course but overall….uncomfortable.
  • As a result of the new patient issue, my overall visit numbers suffered and were down 33.8%. So, we saw 33.8% less visits over the course of the year in 2020. When you consider the value of one visit in my office, well…..let’s just say that adds up to a considerable amount of income lost.
  • You’ll start to see a theme here when I tell you that my total services billed were down 36.6% and net services when we remove our write-offs sat at about 40% down. Ugh, right? But, we worked hard on our billing, of course. When you have extra time, you turn to billing and collections efforts. As a result, our total collections were only down 25.4%. Funny how that happens. 
  • We could go through a whole bunch of different metrics but I have an amazing guest today we need to get to. The most important stat is the final overall total. When we include all of the things that make us money like chiropractic, rehab, laser, decompression, acupuncture, massage, and on and on….when we combine it all, our total collections across the board were down 25.4% in 2020. While that’s a tough pill, I’m not alone. Many of you have had the same difficulties. Many of you have had it worse. And I’m sorry. It’s been difficult for us all. But the good news is that I think it’s lightening up and if improvement and progress makes us all feel good, it won’t take much to improve and show progress over 2020. Will it? I think not so here’s to all good things in 2021. Let’s get all of our practices back on track and help some folks get out of pain and avoid surgery. 

Now, without further adieu, let’s get to our guest today.  Today we are joined by the always interesting and talented Dr. Bobby Maybee hailing from the Pacific Northwest. Portland, Oregon to be exact. Dr. Maybee initially began the Forward-Thinking Chiropractic Alliance (FTCA) in 2014 as an attempt to change the landscape and conversation of the chiropractic profession of social media.   

Since then the FTCA has gone on to create evidence-based content in a grass roots nature.  This content is typically for the internet, and in an educational format through continuing education courses, and is staunchly evidence based.   Dr. Maybee hosts “Forward, The Podcast of the Forward-Thinking Chiropractic Alliance.”  As well, he was just elected Chair of the Oregon Board of Chiropractic Examiners Peer Review Committee, and is a member and supporter of the American Chiropractic Association.  

Dr. Maybee is a 2004 graduate of Western States Chiropractic College.  In his free time, he co manages a household of 5 children, 2 dogs Jett and Abbie, and a cat named Goober. And the best reason we can ever have to thank someone for something, Dr. Maybee is a veteran of the US Air Force which no doubt lends itself to him being such a good and effective leader. 

Welcome to the show Bobby, tell me how Portland is this morning.

How’s the weather? 

Introduction

  • Tell me your chiropractic story. Why chiropractic for you?
  • Tell me what got you to the place where you are the expert in the clinic that you are. What experiences or certifications built that person?
  • Tell me about your practice in Portland
  • With as many kiddos as you have and as many things as you’re involved in, what does a typical week look like for you.
  • How did the FTCA get started?
  • I see here and there online that some vitalists have really started to make the term ‘evidence-based’ a keyword, a trigger word, or a point of conterntion. Have you noticed that as well and how do you think a healthcare profession come to mock evidence and research?
  • What is your vision for the FTCA and what does the group to to move closer and closer to accomplishing them?
  • I was at the Forward 19 event in St Louis and really enjoyed it. Tell us about what goes into creating something like that? How do you pull it off?
  • Recently, I have been on a rant. I see vitalists say kooky stuff and I’m physically and mentally unable to ignore it. I have a recent episode on a guy that wants to teach other chiropractors how to treat 9 new patients and 99 established patients within three hours. Then I had an episode on the shake up of the WFC Research committee. As I mentioned in the episode, you were there in Berlin when it all started going sideways. Can you walk us through it all as far as you know it to be?
  • I think I’ve seen you vacillate on the topic of unity or not. Where do you stand on the whole deal? Is it possible the two sides can continue to live together? Or do you see groups like the Primary Spine Practitioner start to gain steam?
  • Tell us about the CSA that you and Dr. Kevin Christie have put together.

CHIROUP ADVERTISEMENT

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Evidence based chiropractic forward podcast

Primary Spine Care, Frozen Shoulder, & Evidence-Based Chiropractic & Cost

December 31, 2020 chiropracticforward Chiropractic, Chiropractic Forward Podcast, Chiropractic Specialization, Chiropractic Standardization, Evidence Based Chiropractic, Evidence-Based Chiropractic, Evidence-based Chiropractor, Shoulder Pain 00:28:54 0 Comments

CF 158: Primary Spine Care, Frozen Shoulder, & Evidence-Based Chiropractic & Cost

Today we’re going to talk about Evidence-Based Chiropractic, We talk about the primary spine care model integrated into a primary care setting. What happens when that’s the mode of treatment? Then we’re going to talk about some Frozen Shoulder (adhesive capsulitis) research in JAMA recently.   But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #158 Now if you missed last week’s episode, we talked about chiropractors that spread misinformation, we talked about patients needing movement, and we talked about love. I’m a softy at heart believe it or not. Make sure you don’t miss that info. Keep up with the class. Evidence-Based Chiropractic is catching on!

On the personal end of things….. We are sitting here on a Monday 12/21 as of the typing up of this episode. Christmas is upon us. Nothing crazy special going on beyond that.  There are a couple of things I’ll mention. The first is that I got the Mirror gym you hang on a wall. It’s basically like having a trainer in your living room. Lots of you are already used to this sort of a deal with products like Peloton but it’s new to me and it’s pretty awesome. I’m doing stuff like Tai Chi, yoga, boxing, kickboxing, and stuff like that.

Stuff I’d never do otherwise and it’s pretty darn cool.  We turned what used to basically be a dog room into a small gym and it’s been pretty cool so far. I’m enjoying it. I’ve always been a skinny dude stuck in a big dude’s body. So, now that I’m down 33 lbs on weight watchers, and I’ve added the home gym to the mix, I feel like I’m on the way to realizing the skinny dude. Eventually. Lots of work left to do first though. 

Secondly, I’m getting the vaccine in a day or two if everything works out. I have mentioned several times on the podcast that I have very positive relationships with a lot of folks in my local medical community. Through that network, my wife and I will be getting ours this week. I’m ready to get that dude and start moving on with life. 

No, I’m not worried about it. Understanding I have some level of influence and some level of leadership with my friends, family, and patients, I feel it’s important to get out front and set an example on this deal.  Especially being a chiropractor. When you see so many of us disenfranchised because of the vitalists in our profession out there preaching the harms of vaccines when they wouldn’t know how to make it through a research paper on the vaccine to save their lives…..well, wouldn’t it be refreshing to see evidence-based chiropractors stepping up and leading the way on this vaccine? Here’s my stance on it. Maybe it helps you if you’re on the fence. Maybe it doesn’t but here it is anyway.  I’m not an epidemiologist or a maker of vaccines. I have researched masks, COVID, the transmission of Covid, and things like that. Not as much on the vaccine on the vaccine itself though. 

Scientists understand so much more about that sort of research than I’ll ever know. A Fox Poll says 61% of Americans will get the shots while only 23% are strictly against taking it. There were 16% unsure. Probably the ones waiting to see if everyone does OK with it before they step up. And I don’t think that’s unreasonable.  The point is, those getting it like me…..I’m not the minority on it. For me, it’s not only about life or death. I have a 20-something-year-old patient that can’t go back to work because she’s still positive 6 weeks later. I know a nurse that was positive for over nine weeks. I know Patients that had to go to physical therapy for weeks. Long haulers is a real deal. In the end, it’s an easy decision for me. I’m not worried at all really.

There’s risk crossing the road. If I get sick, I have to close my office for at least 2 weeks if not more. That means I lose a lot of money, there will be patients drop off of the schedule, we’ll miss new patients, and I’ll be sick AND anxious the entire time. If COVID doesn’t make me nauseous, the destruction of my business while I’m out sick will.  Besides myself, I have 13 or so other employees and their families depending on my presence. My business depends on my presence and does not run when I’m not there. That’s a little different than a lot of other folks. I’m not doing that if I can prevent it. If a vaccine allows me to prevent it, well then, a vaccine it is.

We chiropractors work within inches of people’s faces and in close contact with them. That puts us at more risk than the average Joe and, if we have it, puts our patients at serious risk of getting it from us.  If you’re like me, we work with a lot of elderly and immunocompromised patients. I’m not willing to put them at risk like that when all I had to do was trust in science and just get the damn vaccine. They ran human trials on 35000-45000 or so people with no unacceptable issues. That’s a huge sample size. I’ve seen this thought on the FTCA group before. It’s probably a Bobby Maybee special quote but, back before Facebook, people would have just taken the vaccine.

They weren’t worried about this stuff back before Facebook told them to worry about it.  No matter what’s out there these days, you have people casting doubt on it for zero reasons. Maybe it’s a call for attention at all costs. Who knows? But it’s to the point now where science and experts are constantly doubted and discounted. And that’s about as dumb and dangerous as can be.  It was OK to cure smallpox and polio but COVID……nah bruh.

If there were real questions, would basically the entire medical complex be in line taking it? My guess is that they wouldn’t.  What if someone can afford to be out of work or out of their office for 2-4-6 weeks and they want to wait to get it? I think it’s reasonable if someone wants to wait to see if anyone has adverse effects before they take it. I don’t think that’s unreasonable at all. But I think that it’s just delaying the fact that almost everyone is going to do fine with it and most people are going to end up getting it.

They started it in England two weeks ago. Nothing has happened. Because they already did the test trials to make sure nothing would happen. Considering the success of the testing, I think the people not getting it are at far more risk than the people that are getting it. Besides all that, I’m ready to get back in my life. Traveling, doing fun stuff, having a life…..important stuff. Like seeing my mom and step pops and being able to visit my dad in the nursing home for the first time since March.

More power to those that have been doing those things all along but for the above-mentioned reasons, we have not.

So that’s where I’m at. We are all on our own walk and we all need to do what we think is best. Staying healthy, staying open and available, and continuing to provide for my family, my staff, and my patients are what I think is best.  So, I’m out front on this. It’ll be good for my patients and family to see a picture of me getting my vaccine on social media. It’ll be good for my patients to see it.

And it’ll be good for those in the medical community that is friends with me to see it. It’ll reaffirm that no….I’m not one of THOSE chiropractors.  I encourage you to be out front with it if you get one. Be a leader and blaze the trail.  And Merry Christmas, Dammit. 

Item #1 The first one today is called “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study” by Whedon, et. al. (Whedon JM 2020) and published in the Journal of Manipulative and Physiological Therapeutics on September 1, of 2020. And that’s a blistering blast of hotness.  If you don’t recognize the Whedon name, he is very prolific in chiropractic research. 

Why They Did It

The objective of this investigation was to compare the value of primary spine care with usual care for the management of patients with spine-related disorders within a primary care setting.

How They Did It

  • They retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system
  • Designated clinicians serve in the role as primary spinal care as the initial point of contact for spine patients, they coordinated the care, and they followed up for the duration of the episode of care
  • A primary spinal care doctor may be a chiropractor, PT, or medical or osteopathic physician trained in primary spinal care for spine-related disorders
  • They had sites where the primary spinal care was implemented as well as control sites where they just stuck with the usual care model
  • They examined clinical encounters occurring over a 2 year period from February 2016 to March 2018. 

What They Found

  • Primary spine care was associated with reduced total expenditures compared with usual care for spine-related disorders
  • At site one, the average per-patient cost was $162 in a year and $186 in year two. 
  • That is compared to site II, a control site, where the cost in year one was $332 and $306 in year two. And in site three, also a control site offering only usual care, where the cost in year one was $467 and year two was $323

Wrap It Up

Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization but may be no more effective than usual care regarding clinical outcomes.

CHIROUP ADVERTISEMENT

Item #2

Our second item today is called “Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis” by Challoumas, et. al. (Challoumas D 2020) and published in JAMA Open on December 16, of 2020 and it does not get one degree hotter than that people!

Why They Did It

The authors here wanted to know the answer to the question, “Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments?”

How They Did It

  • It was a meta-analysis of 65 studies with 4097 participants
  • They searched Medline, EMBASE, Scopus, and CINHAL in February 2020.
  • Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
  • Data were independently extracted by 2 individuals
  • Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome
  • Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.

What They Found

  • Despite several statistically significant results, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain
  • Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to the intra-articular corticosteroid may be associated with added benefits in the mid-term

Wrap It Up

The findings of this study suggest that the early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.

Item #3

Now, on to Evidence-Based Chiropractic. Our third and final one this week is called “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study” by Whedon et. al. (Whedon JM 2020) and published in the Chiropractic and Manual Therapies on December 14, 2020. Get your red hots right here, get ‘em hot right here.  I told you Whedon was prolific. That’s two papers in this one episode that he’s the lead author on and I did not do that on purpose. I didn’t realize who the authors of the papers were until I started typing. He’s on his A-game. 

Why They Did It

The abstract for our Evidence-Based Chiropractic talk leads off by saying, “Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found to be cost-effective for the treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost-effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.” How They Did It

  • It was a retrospective cohort design to examine the costs of chiropractic care among patients diagnosed with acute or subacute low back pain.
  • The study time period ranged between 07/01/2016 and 12/22/2017
  • They compared cost outcomes for patients of two cohorts of chiropractors within the health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain.
  • They used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.
  • A total of 25,621 unique patients were included in the analyses

What They Found

  • The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326
  • Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.

Wrap It Up In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.

So….just who the hell do you all know that’s been preaching this until his face is about to explode? That’s right, listeners of this podcast. One word, two syllables…..Day-um.  Evidence-based and patient-centered care is the future of chiropractic. It is first and foremost, treating our patients with respect and the best care and that’s what they deserve.  Secondly, it’s speaking the language of the medical community. Which is the language of research. When you’re using their language, you’re starting to communicate more effectively.  I think it’s time for superhero sound effects….boom, pow, snap, kawachow!

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

  • Challoumas D, B. M., McLean M, (2020). “Comparison Of Treatments For Frozen Shoulder: A Systematic Review and Meta-Analysis.” JAMA Open 3(12): e2029581.
  • Whedon JM, B. S., Dennis P, Fischer VA, Russel R, (2020). “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study.” Chiropr Man Therap 28(68).
  • Whedon JM, T. A., Bezdijan S, (2020). “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study.” J Man Physiol Ther 43(7): P667-674.