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Lower Medicare Costs for Chiropractic Users with Chronic Low Back Pain and Multiple Comorbidities

Low Back Chiropractic AdjustmentMost low back pain in older adults can be managed non-surgically.  Randomized controlled clinical trials have shown that chiropractic manipulative treatment (CMT) is an effective, conservative treatment option for LBP. With this in mind, the authors of a new analysis wanted to explore whether older Medicare fee-for service beneficiaries with an episode of LBP and multiple comorbidities who obtained CMT during their episode had lower costs than those who did not.

This study was an observational, retrospective study that used Medicare fee-for-service data from 2006 to 2012 to identify older (aged 66 to 99) patients who had a discrete episode of cLBP.  The study included 4 groups of patients who used: 1) only CMT; 2) conventional medical care followed by CMT; 3) CMT followed by conventional medical care; and 4) only conventional medical care.

For these 4 treatment groups, the authors used un-weighted and propensity-score weighted inflation- and price-adjusted Medicare Part A, B, and D reimbursements during the episode.  Propensity scoring is a powerful tool to strengthen causal inferences drawn from observational studies. Propensity scoring helps in selecting similar patient groups for comparison. Medicare Part A covers hospital, skilled nursing facility, home health and hospice care expenditures. Medicare Part B covers doctors’ services and other outpatient expenditures; and Medicare Part D covers prescription medications. Particular attention was given to Part B reimbursements for chiropractic care, psychiatric care, physical therapy care, and spinal manipulation therapy (SMT) provided by doctors of osteopathy (DOs) as well as to Part D reimbursements for pain medications.

The study also looked at rate of spine surgery within 1 year of the end of the episode as well as compound rates of growth for price and inflation-adjusted Medicare expenditures. In addition, the study examined expenditures for psychiatric visits and pain medications.

Results:

  • Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone
  • CMT only patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode
  • Costs were greatest for patients receiving medical care alone
  • Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories
  • Patients who used only CMT had the lowest Part A and Part B expenditures per episode day, although there was no indication of lower psychiatric or pain medication expenditures associated with CMT

Key Points:

  • Among older, multiply-comorbid Medicare beneficiaries with a chronic low back pain episode, chiropractic manipulative treatment was associated with lower overall episode costs and lower episode costs per day
  • Use of CMT was associated with lower total Part A and Part D Medicare cost growth for multiply-comorbid patients with chronic low back pain episodes over the course of the study period
  • The authors found overall Medicare cost-savings associated with use of chiropractic care
  • There was no evidence of lower psychiatric or pain medication expenditures associated with CMT

Reference:

Weeks WB, Leininger B, Whedon JM, Lurie JD, Tosteson TD, Swenson R, O’Malley AJ, Goertz CM. The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities. J Manipulative Physiol Ther. 2016 Feb 19. pii: S0161-4754(16)00007-5.

Are Visits to Chiropractors Attributable to Medication Side Effects?

12394403_sWith so many people taking prescription medication, there is a distinct possibility that the side effects of such medications may be responsible for the symptoms for which patients seek chiropractic care.  In a recent study in Australia, 549 prescription medications were used by 330 patients.  A total of 104 individual medications were identified of which 69 listed headache as a potential side effect of their use. Fifty-seven patients who sought care for the treatment of headache were using medication which may produce headache as a side effect of its use.  There is a need for chiropractors to be aware of the side effects of prescribed medication their patients may be taking. This is the case not only because of the potential for adverse interaction between treatments, but because symptoms produced by prescribed medication may be responsible for the patient’s clinical presentation.

http://www.ncbi.nlm.nih.gov/pubmed/26850807

 

Dr. Scott Haldeman - Pioneering Chiropractic Research, Chiropractic Science

009- Scott Haldeman, DC, PhD, MD: Pioneering and Contemporary Chiropractic Science

Haldeman1In this episode, it is my great privilege to interview Scott Haldeman, DC, PhD, MD.  Dr. Haldeman is a pioneer of chiropractic science and a world leader in spine research. Dr. Haldeman holds the positions of Adjunct Professor, Department of Epidemiology, School of Public Health, University of California, Los Angeles, and Clinical Professor, Department of Neurology, University of California, Irvine.

He is Past President of the North American Spine Society, the American Back Society, the North American Academy of Manipulative Therapy, and the Orange County Neurological Society, and is currently Chairman Emeritus of the Research Council of the World Federation of Chiropractic. He is certified by the American Board of Neurology and Psychiatry and is a Fellow of the Royal College of Physicians of Canada and a Fellow of the American Academy of Neurology. He is a Diplomat of the American Board of Electrodiagnostic Medicine, the American Board of Electroencephalography and Neurophysiology and the American Board of Clinical Physiology. He also served on the US department of Health AHCPR Clinical Guidelines Committee on Acute Low Back Problems in Adults as well as four other Clinical Guidelines Committees. He presided over The Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders.

Scott Haldeman sits on the editorial boards of six journals, and has published over 200 articles or book chapters, over 70 scientific abstracts, and has authored or edited seven books. He was awarded an honorary Doctor of Humanities degree from the Southern California University of Health Sciences and an honorary Doctor of Science degree from the Western States Chiropractic College. He received the David Selby Award from the North American Spine Society. A resident of Santa Ana, California, he maintains an active clinical practice.

World Spine Care is a global charity on a mission to treat the disease with the greatest economic impact in the developing world: Spinal Disorders. To donate or volunteer to the project, please click below.

 

World Spine Care

 

For a list of Dr. Haldeman’s scientific publications please click here.

Here is a list of the publications we discuss during this interview:

1. The McAndrews Leadership Lecture: February 2015, by Dr Scott Haldeman. Challenges of the Past, Challenges of the Present.
Haldeman S, McAndrews GP, Goertz C, Sportelli L, Hamm AW, Johnson C.
J Chiropr Humanit. 2015 Nov 18;22(1):30-46. doi: 10.1016/j.echu.2015.09.001.
PMID: 26770177 [PubMed] Free PMC Article
Similar articles
2. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States.
Dagenais S, Brady O, Haldeman S, Manga P.
BMC Health Serv Res. 2015 Oct 19;15:474. doi: 10.1186/s12913-015-1140-5. Review.
PMID: 26482271 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
3. Commentary: we can tell where it hurts, but can we tell where the pain is coming from or where we should manipulate?
Brady O, Haldeman S.
Chiropr Man Therap. 2013 Oct 21;21(1):35. doi: 10.1186/2045-709X-21-35.
PMID: 24499590 [PubMed] Free PMC Article
Similar articles
4. Advancements in the management of spine disorders.
Haldeman S, Kopansky-Giles D, Hurwitz EL, Hoy D, Mark Erwin W, Dagenais S, Kawchuk G, Strömqvist B, Walsh N.
Best Pract Res Clin Rheumatol. 2012 Apr;26(2):263-80. doi: 10.1016/j.berh.2012.03.006. Review.
PMID: 22794098 [PubMed – indexed for MEDLINE]
Similar articles
5. Is it time to discard the term “diagnosis” when examining a person with uncomplicated axial neck pain?
Haldeman S.
Spine J. 2011 Mar;11(3):177-9. doi: 10.1016/j.spinee.2011.01.032. No abstract available.
PMID: 21377599 [PubMed – indexed for MEDLINE]
Similar articles
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Chiropractic and Midwifery Improve Breastfeeding Rates

A recent study incorporated a clinic of midwives and chiropractors to care for suboptimal feeding through a multidisciplinary approach. Suboptimal breastfeeding is a recognized problem among mothers and health care professionals worldwide. The aim was to assess the impact of care and education on breastfeeding and maternal satisfaction after attending the multidisciplinary clinic. On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. The relative risk ratio for exclusive breastfeeding after attending the multidisciplinary clinic was 3.6  The results from this study demonstrate high maternal satisfaction and improved breastfeeding rates associated with attending the chiropractic and midwifery clinic.

http://www.ncbi.nlm.nih.gov/pubmed/26763046

 

Systematic review says manipulation effective for neck pain

42136910_s (1)New scientific evidence on the effectiveness of manual therapies, passive physical modalities, and acupuncture was assessed in a recent systematic review. This update of the Neck Pain Task Force suggests that mobilization, manipulation, and clinical massage are effective interventions for neck pain. Conversely, they found that electroacupuncture, strain-counterstrain, relaxation massage, and other modalities such as heat, cold, diathermy, hydrotherapy, ultrasound are not effective.

http://www.ncbi.nlm.nih.gov/pubmed/26707074

Dr. Michael Schneider

008- Spine Care Research with Dr. Michael Schneider

Dr. Michael Schneider - Chiropractic Science Podcast
Learn about Dr. Michael Schneider’s chiropractic research on this episode of Chiropractic Science.  Dr. Schneider is a 1982 graduate of Palmer College of Chiropractic and obtained a PhD in Rehabilitation Science from the University of Pittsburgh in 2008. Dr. Schneider has published over 40 peer-reviewed articles on various musculoskeletal topics, and has received over $3 million in US research grant funding from the National Institutes of Health (NIH) and Patient Centered Outcomes Research Institute (PCORI). Dr. Schneider is currently implementing a large randomized clinical trial comparing various types of non-surgical treatment options, including chiropractic care, for patients with lumbar spinal stenosis. We will discuss the clinical significance of his past and present chiropractic research efforts.

Topics for this episode include:

  • A paper published in the journal Spine comparing spinal manipulation and usual medical care for acute and subacute low back pain: a randomized clinical trial
  • Evidence and the chiropractic identity
  • An article regarding US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey
  • A paper in Chiropractic and Manual Therapies describing on ongoing study consisting of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Treatment is randomized into 3 groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise.
  • Three consensus documents for the chiropractic profession including: 1) chiropractic care in health promotion, disease prevention, and wellness; 2) chiropractic care of older adults and; 3) chiropractic care for infants, children, and adolescents.
  • An observational intervention study dealing with a hospital-based standardized spine care pathway. The study looked at implementing a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. In the study, chiropractors were the main providers.

Here’s the link to the Foundations of Evidence Informed Practice modules that Dr. Schneider mentions in this podcast.  The course is hosted at the the University of Minnesota Center for Spirituality & Healing – Advancing the health and wellbeing of individuals, organizations and communities.

http://www.csh.umn.edu/research/foundations-evidence-informed-practice-modules

 

Dr. Christine Goertz

007- Advancing Chiropractic Research with Dr. Christine Goertz

Dr. Goertz
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Learn about the largest study of chiropractic to date, chiropractic effectiveness and cost studies and why there is so much heterogeneity in chiropractic research.  My guest on this episode of chiropractic science is Christine Goertz, D.C., Ph.D.  Dr, Goertz is Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic. Dr. Goertz has extensive experience in the administration of both Federal and non-Federal grants, serving as both a PI (Palmer College of Chiropractic and the Samueli Institute) and as a funding official (NCCIH/NIH, Samueli Institute and PCORI).  She is a veteran integrative healthcare researcher, author and speaker.  Dr. Christine Goertz has served as a principal investigator or co-principal investigator for a number of large-scale, federally funded research studies including a $7 million, Department of Defense-funded collaboration with RAND and the Samueli Institute conducting the largest study of chiropractic to date (currently ongoing).  For over 20 years, she has addressed multidisciplinary science and health policy issues at the state and federal levels, serving as a member of the American Medical Association’s Measures Implementation and Evaluation Advisory Committee, Chair of the American Chiropractic Association’s Performance Measurement Task Force, and a program officer of the NIH National Center for Complementary and Alternative Medicine managing a portfolio focused on musculoskeletal disease, pain and health services research. She is a Fellow of the International College of Chiropractors. She received her doctor of chiropractic from Northwestern Health Sciences University and a PhD in Health Services Research Policy and Administration from the University of Minnesota.

20 for 20 Campaign to benefit chiropractic research

With $20, We can #ChangeLives.

We can be part of a small effort that will have a big impact. We can use research to help children with headaches or middle ear infections. We can improve access to chiropractic care nationwide. We can help train the chiropractic researchers of the future.

We’re in! Are You?

1995 – 2015: The Palmer Center for Chiropractic (PCCR) has significantly impacted the science of chiropractic for two decades, and has grown to become the largest and most productive chiropractic research center in the world.

Our goal is to celebrate 20 years of chiropractic research at Palmer by connecting with 20,000 friends who are willing to donate $20 each year toward the following key research efforts at the PCCR:

  • Initiate pilot studies in new areas of research that could lead to federal funding opportunities, such as studies on chiropractic for headaches in adolescents
  • Conduct research on how to improve access to chiropractic care within patient centered medical homes and accountable care organizations
  • Study the cost-effectiveness of chiropractic care in a rigorous manner
  • Provide training grants to help chiropractic students and professionals to become skilled chiropractic researchers
  • Develop studies focusing on chiropractic co-management for conditions for which antibiotics are no longer considered the first line of defense, such as chiropractic/pediatric co-management of otitis media in children, or chiropractic/primary care co-management of chronic bronchitis

Your support enables us to conduct rigorous clinical studies designed to provide evidence that lends validity, reliability, and continuity to the work of chiropractors worldwide.

Are you in?

Give Now!

Dr. Heidi Haavik

006- Brain Adjustments with Dr. Heidi Haavik

HeidiHaavik
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Learn what happens in your brain when a chiropractor adjusts your spine.  Dr Heidi Haavik is a chiropractor and a neurophysiologist who has worked in the area of human neurophysiology for over 15 years. Heidi has a PhD in human neurophysiology from the University of Auckland. Her work has been instrumental in building the base of scientific evidence demonstrating the efficacy of chiropractic care in improving people’s health and wellbeing. As a researcher, she has investigated the effects of chiropractic adjustments of dysfunctional spinal segments (vertebral subluxations) on somatosensory processing, sensorimotor integration and motor cortical output.

Dr Haavik is the Director of Research at the New Zealand College of Chiropractic where she has established the Centre for Chiropractic Research. Dr Haavik is also an Adjunct Professor at the University of Ontario, Institute of Technology in Oshawa, Canada and is a member of the World Federation of Chiropractic’s Research Council. Dr Haavik has received numerous research awards and has published a number of papers in chiropractic and neurophysiology journals. She has presented her work to both chiropractic and neuroscience communities around Australasia, North America and Europe. She is on the Editorial Board of the Journal of Manipulative and Physiological Therapeutics and Journal of Chiropractic Education. She was named Chiropractor of the year in 2007 by both the New Zealand Chiropractic Association and the New Zealand College of Chiropractic Alumni Association.  She is also the author of a textbook – The Reality Check which describes in easy to understand language what happens in the brain when a chiropractor adjusts dysfunctional segments in your spine.

Read about Dr Haavik at her website, and get her book and posters at heidihaavik.com.  Subscribe to Dr Haavik’s research service at haavikresearch.com to get great evidence-informed marketing material for chiropractic practices including among other things, videos for your website that explain how chiropractic works.  Interested in donating toward her research efforts?  Contact her at haavikresearch.com.

HeidiDean2015

Dr. Haavik and Dr. Smith at the Ohio State Chiropractic Association Convention, 2015

reality check

Dr. Haavik’s book: The Reality Check

Dr. Steven Passmore

005- Human Performance with Dr. Steven Passmore

Passmore Headshot 2012

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Listen to Dr. Dean Smith interview Dr. Passmore regarding the science relating chiropractic to human performance. Dr. Passmore is Assistant Professor in the Faculty of Kinesiology & Recreation Management at the University of Manitoba.  He also holds adjunct appointments in the College of Rehabilitation Sciences at the University of Manitoba, the Research Department at New York Chiropractic College, and the University of Ontario Institute of Technology.  His expertise deals with human perceptual learning and motor control.  Dr. Passmore utilizes his theoretical and applied background in perceptual motor behaviour to explore performance-based outcome measures in an attempt to objectively determine population characteristics, movement outcomes and sustainability of interventions.  Dr. Passmore practiced as a chiropractor in the Buffalo Veterans Affairs Medical Center (2007-09), and is currently in practice in Manitoba. He has held competitive grants from the Canadian Institutes for Health Research (CIHR), the Worker’s Compensation Board of Manitoba (WCB), Research Manitoba (RM), the Manitoba Medical Service Foundation (MMSF), and the Alexander Gibson Fund.

Dr. Steven Passmore

Chiropractic Science Podcast with Dr. Steven Passmore

Dr. Dean Smith will be hosting a podcast interview with Dr. Steven Passmore this Thursday, September 24th at 2 pm (EST).

Passmore Headshot 2012Steven Passmore, DC, PhD.  Dr. Passmore is Assistant Professor in the Faculty of Kinesiology & Recreation Management at the University of Manitoba. His expertise deals with human perceptual learning and motor control.  Dr. Passmore utilizes his theoretical and applied background in perceptual motor behaviour to explore performance-based outcome measures in an attempt to objectively determine population characteristics, movement outcomes and sustainability of interventions.  We will discuss Dr. Passmore’s chiropractic and performance related research. To hear the podcast live, go to chirocredit.com/chiropracticscience and login for instructions (Not a member? Create an account for free).