1. Chiropractic Physicians Filling the Role of Non-surgical Spine Specialists A West Hartford Group Presentation

2. © 2009 West Hartford Group Agenda LBP Management and the Need for a Nonsurgical Spine Specialist Current Strategies in LBP management Evidenced-based interventions Fiscal Impact Access DC’s as the Nonsurgical Spine Specialist Integration WHG MVV

3. © 2009 West Hartford Group Common LBP Management Strategies Medications, bed rest, recommended inactivity Possible directed exercise programs (PT) Imaging/ advanced imaging Facet/ Epidural injections Surgical intervention – discectomy, fusion, rhizotomy, etc.

4. © 2009 West Hartford Group LBP Interventions Lacking Evidence Bed rest and inactivity Most prescription meds for LBP Epidural and other spinal injections Surgery for many acute LBP/sciatica conditions. Rhizotomy

5. © 2009 West Hartford Group LBP Interventions with Good Supporting Evidence Manipulation Exercise Biopsychosocial approach to activating patients and reducing fear of movement.

6. © 2009 West Hartford Group Implications of Current Non- Evidence Based Recommendations Catastrophizes LBP and induces passive coping strategies in the patient Leads to increased chronicity due to inappropriate application of therapies and the patient’s psychological outlook on their ability/ disability Creates a high cost-burden on the healthcare system overall

7. © 2009 West Hartford Group Fiscal Impact of LBP Back pain management in the USA is extremely costly primarily due to the lack of application of the best available evidence to clinical practice. The most expensive aspects of LBP care are prescription drugs and advanced diagnostic imaging/testing.

8. © 2009 West Hartford Group Fiscal Impact of LBP By applying evidence-based back pain management protocols, patients will have greatly improved outcomes at a lower overall cost individually and to the healthcare system as a whole.

9. © 2009 West Hartford Group Access to Appropriate Care There has been a trend of an overall decline of doctors going into general practice medicine. With LBP being the one of the highest presenting complaints into a GP’s office, there will be a growing need for access to appropriate care.

10. © 2009 West Hartford Group DC’s – Fulfilling a need Evidence-based DCs as non-surgical spine specialists can fulfill this need in the healthcare system of the 21st century. By applying the evidence, DC’s can serve as portal of entry physicians to improve patient outcomes and reducing current cost burden of spine care.

11. © 2009 West Hartford Group Integration Integration of DC’s in the general healthcare community is key to the success of this model. Current examples: Hospital-based back pain programs Integrated private group practices (MD, DO, DC) ER-based DC care Integrated referral systems for private practices

12. West Hartford Group, Inc Mission, Objectives, Values

13. © 2009 West Hartford Group West Hartford Group, Inc - Mission WHG, Inc. is a think tank dedicated to the acquisition of social, cultural and professional authority for the chiropractic profession, where the Doctor of Chiropractic serves within the mainstream health delivery system as a patient-centered, evidence based musculoskeletal specialist.

14. © 2009 West Hartford Group West Hartford Group, Inc – Objectives (Vision) To provide the profession with a viable model of integrative practice. To foster inclusion of WHG members in the fabric of the profession to promote WHG’s mission. To create a public and professional image of chiropractic as a profession dedicated to scholarship, research and the patient-centered, evidence-based practice paradigm. To advance chiropractic education (undergraduate & graduate) and scholarship consistent with WHG’s mission.

15. © 2009 West Hartford Group West Hartford Group, Inc - Values Chiropractors are healthcare providers who provide non-surgical clinical management of musculoskeletal (MS) conditions, with an emphasis on the spine. Chiropractic clinical management includes diagnosis and treatment, with an emphasis on prevention, rehabilitation, wellness and holism. Objective measurable treatment effectiveness must be demonstrated.

16. © 2009 West Hartford Group West Hartford Group, Inc - Values A Bio-psycho-social (BPS) approach is essential for the management of pain and dysfunction. Treatment must focus on active care that empowers the patient toward management of his/her own healthcare. Treatment goals must be functional, and focused on return to normal activities of daily living (ADL) and improved quality of life. Treatment must be based upon the best evidence available.

17. © 2009 West Hartford Group Questions and Discussion