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Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

The Chiro.Org Blog

SOURCE:   Journal of Occupational Rehabilitation 2017 (Sep)

Marc-André Blanchette, Michèle Rivard, Clermont E. Dionne, Sheilah Hogg-Johnson, Ivan Steenstra

Public Health PhD Program,
School of Public Health,
University of Montreal,
Montreal, QC, Canada.

Objective   To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers.

Methods   We analyzed data from a cohort of 5,511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2–year follow-up period.

Results   Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10–1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71–0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02–2.19], P value = 0.040) rather than a physician (reference).

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Experiences With Chiropractic Care for Patients With Low Back or Neck Pain

The Chiro.Org Blog

SOURCE:   J Patient Exp 2020 Jun;   7 (3):   357–364

Ron D Hays, PhD, Cathy D Sherbourne, PhD, Karen L Spritzer, BS, Lara G Hilton, PhD, MPH,
Gery W Ryan, PhD, Ian D Coulter, PhD, and Patricia M Herman, ND, PhD

Division of General Internal Medicine & Health Services Research,
UCLA Department of Medicine,
Los Angeles, CA, USA.

Background:   Musculoskeletal disorders are the second leading cause of disability worldwide.

Objective:   Examine experiences of chiropractic patients in the United States with chronic low back or neck pain.

Method: &nbsp Observational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care.

Results:   We found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points).

Conclusions:   The positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care.

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CHRONIC NECK PAIN Section and our

LOW BACK PAIN Section

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Access to Chiropractic Care and the Cost of Spine Conditions Among Older Adults

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SOURCE:   American J Managed Care 2019 (Aug); 25 (8): e230–e236

Matthew A. Davis, PhD, DC, MPH et. al.

Matthew A. Davis, PhD, DC, MPH
University of Michigan,
400 N Ingalls St, Room 4347,
Ann Arbor, MI 48109.

Objectives:   Chiropractic care is a service that operates outside of the conventional medical system and is reimbursed by Medicare. Our objective was to examine the extent to which accessibility of chiropractic care affects spending on medical spine care among Medicare beneficiaries.

Study Design:   Retrospective cohort study that used beneficiary relocation as a quasi-experiment.

Methods:   We used a combination of national data on provider location and Medicare claims to perform a quasi-experimental study to examine the effect of chiropractic care accessibility on healthcare spending. We identified 84,679 older adults enrolled in Medicare with a spine condition who relocated once between 2010 and 2014. For each year, we measured accessibility using the variable-distance enhanced 2-step floating catchment area method. Using data for the years before and after relocation, we estimated the effect of moving to an area of lower or higher chiropractic accessibility on spine-related spending adjusted for access to medical physicians.

Results:   There are approximately 45,000 active chiropractors in the United States, and local accessibility varies considerably. A negative dose–response relationship was observed for spine-related spending on medical evaluation and management as well as diagnostic imaging and testing (mean differences, $20 and $40, respectively, among those exposed to increasingly higher chiropractic accessibility; P <.05 for both). Associations with other types of spine-related spending were not significant.

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Leadership and Capacity Building in International Chiropractic Research: Introducing the Chiropractic Academy for Research Leadership (CARL)

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SOURCE:   Chiropractic & Manual Therapies 2018 (Feb 6); 26: 5

Jon Adams, Greg Kawchuk, Alexander Breen, Diana De Carvalho, Andreas Eklund, Matthew Fernandez, Martha Funabashi, Michelle M. Holmes, Melker S. Johansson, Katie de Luca, Craig Moore, Isabelle Pagé, Katherine A. Pohlman, Michael S. Swain, Arnold Y. L. Wong, and Jan Hartvigsen

Faculty of Health,
University of Technology Sydney,
Sydney, Australia.

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives.

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New Law Protects Chiropractors Who Travel with Sports Teams

The Chiro.Org Blog

SOURCE:   American Chiropractic Association
Annette Bernat
American Chiropractic Association

Arlington, Va.– The American Chiropractic Association (ACA) is pleased to announce that Congress has approved legislation that will protect chiropractors who travel with sports teams by ensuring that their license and liability insurance remains in effect even when they cross state lines.

The Sports Medicine Licensure Clarity Act of 2018, as the bill is known, was included in a larger, unrelated piece of legislation (H.R. 302) that passed the Senate overwhelmingly on Oct. 3. The president is expected to sign the bill in the next several days.

As the bill was being drafted, ACA lobbyists and volunteers worked closely with Rep. Brett Guthrie (R-Ky.), the chief House sponsor, and the House Committee on Energy and Commerce to ensure that doctors of chiropractic would be included in the bill’s final language. The original version may have excluded chiropractors from the list of included “sports medicine professionals.”

“This legislation not only protects chiropractors and other health professionals who travel with sports teams, it also ensures consistency of care for the athletes who rely on them,” said ACA President N. Ray Tuck, Jr., DC.
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VA Chiropractic Residents: Where Are They Now?

The Chiro.Org Blog

SOURCE:   ACA News ~ 3-26-2018

By Stephanie Halloran, DC

Part of a series on the chiropractic residency program in the VA health care system

The blog posts in the VA Chiropractic Residencies series thus far have been focused solely on the current residents’ experiences as they unfold throughout the year. For many, the question remains: What happens after the residency ends? In this post, I summarize what Brian Giuliani, DC, the 2016 graduate of the VA Connecticut Healthcare System, and Kelsey Corcoran, DC, the 2017 graduate of the VA of Western New York Healthcare System, learned from their respective programs, their favorite rotations, where they are now, and what advice they have for students interested in applying for the VA Chiropractic Residency.

Brian Giuliani, DC

Dr. Giuliani, an alumnus of New York Chiropractic College, is currently practicing with the Aurora Spine Institute, a subset of the larger Aurora Healthcare Hospital System, in Sheboygan, Wis. His clinic is comprised of an orthopedic spine surgeon, surgical PA, physiatrist, two spine-specific physical therapists, three chiropractors, and multiple anesthesiologists who perform interventional procedures. In the chiropractic department, Dr. Giuliani primarily treats patients with non-operative musculoskeletal conditions of the neck and low back (with and without radiculopathy) and headache.

The opportunity to train under experienced clinicians during the residency helped bridge the gap between classroom medicine and clinical medicine, according to Dr. Giuliani, resulting in proper application of the knowledge he acquired throughout his schooling. Additionally, he found the program rapidly exposed his clinical deficiencies and afforded him time and guidance to positively augment these areas. The clinical training, in his opinion, is the greatest strength of the residency, with development of interpersonal communication skills coming in a close second. These communication skills are developed by observing the attending chiropractic physician’s interactions with patients, as well as on rotation while working under other medical specialties.

Neurosurgery topped Dr. Giuliani’s list when it came to rotations. Taking place near the end of the year-long program, it was viewed somewhat as a capstone course. Application of the vast knowledge he gained over the year gave rise to competently performing consultations, planning both operative and non-operative strategies, and first-hand learning of some surgical aspects in the operating room. Additionally, he found physiatry and pain management to be valuable as they exposed him to a broad spectrum of musculoskeletal cases not generally seen in VA chiropractic clinics as well as increased his ability to synthesize large amounts of information into a novel management plan.

Dr. Giuliani advises interested students to look at the residency program from an educational perspective, rather than one focused on job security. “You should have an idea of where you want your career to take you, whether that is education, research, administration, etc. You will be presented with an opportunity that few in our profession have…if you approach it as an education opportunity, you will do very well.”

Kelsey Corcoran, DC

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