Protected: 2015 BC Chiropractic Convention – Electronic Notes

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Join us in celebrating World Spine Day on October 16, 2015!

On Friday, October 16, 2015, the Canadian Chiropractic Association will be joined by other provincial associations including the BC Chiropractic Association to celebrate World Spine Day.  Join us as we help bring awareness to ‘Your Back at Work’. The focus this year will be on the importance of education related to good spinal health and prevention of injuries in the workplace.Tell us how you prevent injury and stay well with #YourBackAtWork!  Use our hashtag to share:
  • Your tips and tricks to prevent injury at work.
  • Exercises that help keep you moving on the job.
  • Your healthy habits that help you be more productive.
  • A story about how chiropractic helped you get back to work.
Your Family Chiropractor can provide you with great advice on how you can stay safe on the job.  We also encourage you to check out the following resources:
  • World Spine Day Website  – A great resource to direct your patients to, the World Spine Day public site includes program information and other health resources for patients to educate themselves.
  • Think Twice, Lift Once Program – promoting back safety and injury prevention in the workplace.
  • Straighten Up Canada – Free app with exercises and spine health information.
And of course, watch for our #YourBackAtWork hashtag on social media! 

Improving mobility in ankylosing spondylitis patients

Most patients who are given the diagnosis of ankylosing spondylitis have no idea what the disease is all about. Essentially, ankylosing spondylitis is a form of inflammatory arthritis that localizes in the spine. Because it is an auto-immune disease, the body attacks the facet joints between the vertebra, resulting in fusion and the hallmark forward stooping posture. It is difficult to diagnose and patients can live with it for years undetected. Arthritis is generally thought to be an old person’s disease, however, ankylosing spondylitis is most commonly seen in individuals between 17 and 35 years of age.A new class of drugs called biologics have revolutionized the treatment of auto-immune diseases and many patients are able to improve their quality of life as a result. Dr. Carlo Ammendolia at the University of Toronto says that the use of these drugs actually control the inflammatory process and are life changing for those struggling with the pain ankylosing spondylitis, however, they do not address the fusion of the joints that can impair mobility. Since most people are young when they receive their diagnosis, the thought of not being able to enjoy all of life’s activities because of spinal fusion can be devastating. Through his research, Dr. Ammendolia is working with patients to develop management approaches to help minimize or slow the fusion process.Dr. Ammendolia has identified several tailored exercises that when combined with the drugs can help improve or slow the fusion process. “The exercise program is really geared towards lifestyle and self management where patients are doing things sitting, standing, walking and sleeping in a posture that mitigates that risk to fuse in that posture.” The goal is to improve the muscles around the joints so that optimal posture is maintained. Chiropractic care also plays a role, with carefully considered treatments known as “adjustments” adding to the overall treatment plan to help maintain mobility. Push/relax techniques are used to help regain neck flexibility. In cases where joints are already fused together, adjustment or manual manipulation is not performed.As much as we hate to admit it, most health care, especially disease management, requires commitment from the patient to improve or maintain their wellness. That is of course what Empowered Health is all about, right? With these protocols, Dr. Ammendolia hopes that individuals suffering from ankylosing spondylitis will be “kick started” into self management of the condition. Next steps include developing tools and resources that will help patients track and monitor their progress. For more information, be sure to consult your family chiropractic doctor.

Patient attitudes influence recovery outcome

Why do some patients recovery quickly while others are slow to improve? This question reminds me of that children’s game where “one of these things is not like the other” except in the case with patients who have similar injuries and treatment plans, spotting the differences are much more difficult. Dr. Jason Busse, chiropractic researcher at McMaster University is conducting studies that aim to better identify these variables so that it is easier to distinguish patients who are at risk of a longer recovery from those who require less intervention.Dr. Busse’s initial findings uncovered approximately 100 studies identifying dozens of varying factors that play into a patient’s recovery. These factors ranged from things such as age, patient’s education, coping mechanisms and confidence in the healthcare provider. Thirty factors from the studies consistently predicted recovery, 25 factors showed no association to recovery and 60 factors proved inconsistent or lacked evidence to support recovery prediction.Many of the factors that predict recovery were influenced by patient attitudes. The findings suggest that patient beliefs and confidence in their health play a bigger role in recovery than we initially thought. As Dr. Busse puts it “there is a real potential there is seems for the provider by how they convey their impressions to actually influence [the patient’s] prognosis.”The team at McMaster wanted to evaluate the role of patient beliefs and attitudes as a predictor to recovery outcome. A research trial followed a group of patients who required surgery to repair a broken leg, all who received standardized care. Patients were asked to complete a survey one month after surgery about their beliefs and attitudes with recovery and were followed for one year. “What we found was there were 27 items in our survey that separated out the group that had recovered and gone back to work versus the group that has not recovered” reports Dr. Busse, “and all of these variables were potentially modifiable.”This reinforces the importance of the doctor’s role in health as they have the potential to influence the attitudes and behaviours of their patients which could ultimately result in a more favourable patient recovery and sooner return to work. Theoretically, the survey could be given to patients to help gauge their risks and needs. Knowing about these factors can assist health care providers in identifying patients who may require more support with recovery than others. Early intervention with patients who are “high-risk” could ensure a more appropriate course and frequency of treatment. Care could also be better tailored for all patients, depending on their needs detected by the factors.Ultimately, a survey cannot determine how well you will recover; however, it does provide a meaningful tool to help steer health providers in the correct direction. The key is in the doctor’s interpretation of the factors and their delivery of the information to the patient. Dr. Busse’s research is yet another example of the significance of the doctor/patient relationship.

Narrowing the evidence-practice gap

Healthcare research is conducted daily around the world and we often see headlines published on a single topic in newspapers or broadcast on the news. Some of these findings are nothing short of amazing, disc regeneration for example, but most studies provide small steps forward to improve prevention opportunities and recovery time. While most research papers do not garner airtime due to the volume of research, this should not dismiss their significance. But how do we get the attention of the public, or more importantly, the health professional when it comes to these types of studies?Dr. André Bussières DC, PhD holds the CCRF Professorship in Rehabilitation Epidemiology at McGill University. His goal is to develop methods and resources to narrow what some call the evidence-practice gap. This “gap” refers to published comprehensive research and what is practiced by the healthcare provider in the clinic setting. Dr. Bussières says that 30-40% of patients do not receive the best care as a result of this “gap”, so patients aren’t receiving care that is reflective of the latest research. Knowledge transfer is an extremely tricky process and it usually takes a long time to convey the latest best practices to clinicians.One of the reasons why communication is so difficult is because the research is scattered throughout many different journals and publications. To help centralize the information, Dr. Bussières and his team at McGill plan to look at all of the evidence and research available for a given condition or therapy. Once the review is complete and the research is scrutinized, qualifying studies are synthesized into one comprehensive document (also known as a Clinical Practice Guideline or CPG) that explains the research resources and demonstrates best practices supported by the research at that time. This creates somewhat of a road map that the health professional can use to assist with diagnosis and treatment. In addition, CPGs can reinforce a doctor’s experience with patients in practice (practice based evidence) through evidence-based research (what is learnt in the lab).Comprehensive CPGs can be very useful in the transfer of knowledge and support best practices in the clinic setting. These resources are also valuable when discussing expected outcomes and recovery times with insurance providers or patients themselves. The public is more informed about their health now than ever before so it is plausible that patients will have questions and ask for reassurance when receiving a diagnosis and recommended care.