Active Care Continued from Page 11 LOW-TECH PRODUCTS Current research clearly indicates the importance of exercise and mobility in the treatment of low back pain.1 Evans et al. found that manipulation and low- tech rehab was better than manipulation alone, or manipulation and high-tech re- hab, for chronic neck pain patients.2 Al- though outcomes were closely matched, patient satisfaction was the highest in the manipulation and low-tech rehab group. Bronfort et al. also reported simi- lar results that exercise and manipulation combined was more effective than either one alone.3 This is, in fact, a highly ethical way to practise because it reduces patient dependency on passive pain relieving approaches, while teaching patients the self-treatment techniques needed to develop control over their symptoms. One of the most cost-effective ways to implement rehabilitation into your practice is through the use of low-tech products. These products require little space, are supported by the literature, and are inexpensive. Exercise balls, wobble boards/stability trainers, exercise stations, tubing and bands, and rehab wall stations are great products that can address most conditions requiring reha- bilitation. Wall-mounted and floor units are an excellent way to train many of the spine and extremity conditions we see in our offi ces regularly. Core strengthen- ing for spine conditions, and utilization of multiple resistance points for extrem- ity conditions, are the great advantage of wall units. Furthermore, the literature supports the use of progressive resis- tance for treatment of musculoskeletal conditions as well as for improvement of 32 • CANADIAN CHIROPRACTOR | APRIL 2008 function and fitness. One of the best features of low-tech rehab products is their portability. While patients are in active care, as well as when patients have completed care, they can purchase these products from your practice and use them at home to main- tain their progress. Educating patients with regards to the importance of ad- hering to their treatment plans – in-of- fi ce rehab is very different from a home exercise program – and the importance of maintenance visits for the appropri- ate patient population once their active care has been completed is critical. If patients are understanding the benefits of both their continued responsibility to maintain their home exercise program, and their maintenance visits to reduce the probability of recurrences, practitio- ners are assured a happy, healthy patient population, as well as a healthy practice with many referrals from those patients! WHAT THE FUTURE HOLDS Chiropractic rehabilitation strategies need to provide a continuum of care, in- tegrating passive and active treatments. The goal of rehabilitation should be to support and improve the effectiveness of chiropractic adjustments as well as to achieve a positive effect on the entire kinetic chain. Active care needs to be outcome driven. Your treatment plans should document and support your in- offi ce protocols and the ongoing progress for the patient. Take charge of your pa- tient’s care, both within and outside the offi ce. As the practitioner, you can make sure you develop strong home strategy plans for your patients to empower them within their own care. Provide them with the right equipment and simple instruc- tions to make it effortless to comply. By combining expert delivery of pas- sive and active care, along with good doc- umentation and compliance, chiroprac- tors can continue to position themselves as the key providers of cost-effective quality spinal care. Regardless of where you start with implementing active care procedures, there is a program that will work for every doctor and every offi ce. Chiropractors are without a doubt the leaders in providing the best care for their patients. By incorporating the reha- bilitation paradigm into our practices we can guarantee that we stay competitive. Let’s leverage ourselves, and our profes- sion, by learning all we can about the active care evolution revolution that is occurring. • References: 1. Twomey L, Taylor J. Exercise and spinal manipulation in the treatment of low back pain. Spine. 1995 Mar 1; 20(5):615-9. 2. Evans R, Bronfort G, Nelson B, Goldsmith CH. Two-year follow-up of a randomized clinical trial of spinal ma- nipulation and two types of exercise for patients with chronic neck pain. Spine. 2002 Nov 1;27(21):2383-9. 3. Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H. A random- ized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine. 2001 Apr 1;26(7):788- 97; discussion 798-9. www.canadianchiropractor.ca
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