ThE BACK PAgE RESEARCH REvIEW Chiropractors as primary spine care providers (Part 1) S by shawn thistle systemic/inflammatory disease from degenerative processes as well as other causes of spinal pain Specialized training in SRDs and numerous forms of spine care (in-cluding manual therapy, medica-tions, percutaneous injection op-tions, exercise and rehabilitation) Familiarity with surgical interven-tions and their evidence-based in-dications and implications Intimate awareness of the abilities and limitations of other spine care providers and specialists who can provide necessary complementary interventions (both surgical and non-surgical) Evidence-based, scientifically de-fensible, cost-effective, clinical-ly-relevant, collaborative, pa-tient-centred care practices for SRDs Appreciation for minimalism and quality of care to minimize excess spending and the development of treatment dependency Understanding of the unique as-pects of work-related and motor vehicle collisions-related SRDs Broad perspective on the public health correlations with SRDs in-cluding smoking, obesity, lack of exercise, mental health disorders Ability to screen for psychosocial morbidity and professionally com-municate with appropriate provid-ers of care for these conditions and other aspects of biopsychosocial rehabilitation An understanding of pain and chronicity from a biological and clinical research perspective, with working knowledge of the clinical implications for patient communi-cation, establishing realistic expec-tations and approaching case management • Ability to coordinate care among numerous practitioners and follow patients for a prolonged period of time if necessary This is likely not a comprehensive list and is in no particular order, but repre-sents a tall order for an individual clini-cian as it stands. In fact, the true solution to this problem likely exists in a coordi-nated, team-based approach. But, every team needs a leader. The PSCP would function as such a leader and represent the point of first clinical contact for patients with SRDs. The PSCP would also function as a resource for traditional primary care providers (such as family practice phy-sicians, general internal medicine phy-sicians, pediatric, obstetrical/ gyneco-logical physicians) to refer patients who present with SRDs. There is currently no single discipline or professional group that fills this important role. Traditional primary care givers (PCGs)–family physicians–are not well trained in the differential diagnosis and management of musculoskeletal disor-ders, including SRDs. This is likely due to the heavy (and necessary) emphasis on internal diseases in medical school and in primary care residency programs. There is strong body of evidence that published clinical guidelines are not well-implemented in practice. There is also evidence that even those PCGs professing to have a special interest in SRDs tend to have anachronistic beliefs about best practices for assessing and managing these disorders. For more Research Review, visit www.canadianchiropractor.ca. www.canadianchiropractor.ca pine-related disorder s (SRDs) are extremely com-mon and often recurring, potentially debilitating con-ditions that affect just about every individual at some point in the lifespan. In fact, low back pain (LBP) is the second most common symptomatic reason patients consult a family doctor and is now the leading cause of “days with disability” worldwide (neck pain is fourth on this list). SRDs place a massive burden on so-ciety, industry and health-care systems around the globe. Despite a staggering rise in expenditure on advanced diag-nostic imaging, specialist visits, medica-tions and other interventions, the magnitude of improvement in patient outcomes has not been commensurate. In fact, disability resulting from SRDs is rising. There is a pressing need for the estab-lishment and development of a primary spine care provider (PSCP) – a clinical specialty with advanced training in spine care, in-depth awareness of the multifac-torial nature of SRDs, and ability to assist in patient-centred, rational clinical deci-sion-making. Health-care systems des-perately need appropriately trained, skilled clinicians to fill the role of PSCP for the diagnosis and non-surgical man-agement of SRDs – a primary care physician for the spine, if you will. • • • • • • • • PSCP challenge On the surface, the proposed role of PSCP may seem simple, yet to appro-priately fulfill this responsibility, a clini-cian must have: • Astute diagnostic capability, in-cluding the ability to differentiate • Dr. ShAWn thiStle is the founder and president of Research Review Service, an online, subscription-based service to help busy practitioners integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com). 42 Canadian Chiropractor April 2014
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