Understanding chiropractic care in LTC
Those who work in long-term care settings are on the front line of healthcare for a population most deserving of excellence in care. LTC health professionals know all too well that musculoskeletal pain is a common patient complaint. A review of six studies of LTC settings found musculoskeletal pain rates among patients range from 49% to 83%. Even more specifically, a study of nursing home patients found that the most common source of pain was low back pain or LBP.
Thanks to recently released guidelines on low back pain treatment from The American College of Physicians, LTC professionals now have expert guidance. According to ACP, non-drug treatments, including Spinal Manipulative Therapy or SMT, should be tried before drug therapies. Patients with LBP (and their doctors) are increasingly selecting conservative care, including manual therapies, over surgery or opioids/other medications, based on their concerns with side effects, treatment safety, healthcare costs and clinical outcomes.
Today, one commonly used, non-pharmacological, conservative approach to Low Back Pain (LBP) is chiropractic care. But, has this always been the case?
Nation moves towards the use of complementary healthcare
While only 42% of Americans used CAM therapies in 1997, that number increased to approximately 62% by 2002. Estimates of utilization of CAM therapies in older adults is reported between 30% and 47.8%. More recently, a Gallup survey of 31,000 adults assessing utilization of CAM therapies in the US, reported that 14.6% of Americans utilized “manipulative and body based therapies,” including chiropractic and massage in the past year.
The most common conditions treated with these alternative therapies are “arthritis” and back pain, in fact 47% of osteoarthritis patients surveyed used alternative care including massage therapy, chiropractic care and other non-prescribed alternative therapies. For LTC healthcare professionals, these are trends are worth following.
Benefits of chiropractic for LTC patients: a look at the evidence
In a recent systematic review and meta-analysis of 26 randomized clinical trials, spinal manipulative therapy was associated with statistically significant benefits in both pain and function, of on average modest magnitude, at up to 6 weeks.
This study adds to the growing body of science supporting chiropractic care as a preferred treatment for back pain. The authors concluded that SMT was associated with significant improvements in pain and function with no serious side effects. Additional clinical trials have also demonstrated the efficacy, safety and acceptance of chiropractic care in older people.
In addition, studies of Medicare patients report that chiropractic care may provide a protective effect against the declines in ADL's often seen in musculoskeletal pain patients and offer improvements in functional outcomes similar to medical care.
Doctors of Chiropractic can help in LTC settings
There are many compelling reasons why LTC centers consider chiropractic services in their facilities, or as collaborative care agreements.
Chiropractors are among the most effective and cost-effective providers in caring for older adults with musculoskeletal pain. Additionally, chiropractors are trained extensively in physical examination and comprehensive assessment of older adult patients.
Chiropractors could relieve some of the assessment/screening burden in LTC facilities, freeing up other LTC providers to focus on other patient needs.The vast majority of Chiropractors routinely offer health promotion and prevention strategies related to overall health issues such as pain, fall prevention, healthy diet, and physical activities. A DC can utilize these evidence-based health promotion interventions to help LTC patients regain or retain functional independence.
Chiropractic: not a “one size fits all” approach
Chiropractic care is certainly NOT a one size fits all intervention. Chiropractic care can range from manual therapies suited for professional athletes (many professional sports teams have a staff chiropractor) to gentle, minimally invasive techniques that may be more suited, or more accepted for the oldest, frailest patients.
When seeking chiropractic services for your LTC setting, it is prudent to inquire about the training and experience of the DC providing lower-force techniques. Some of the more common chiropractic techniques used in the care of older adults are:
Activator Methods, an instrument-assisted lower force technique
Flexion-Distraction Technique, which uses a specialized table that allows the provider to use gentle flexion and distraction motions, particularly to address spinal concerns in the lower back and neck
Thompson Technique, which uses a specialized table with segments that drop away slightly during the manual procedure, resulting in a lower force intervention
There are numerous other techniques used by DCs, including many that address muscular complaints as well as bone and joint concerns. A DC can be asked to demonstrate these procedures for LTC staff, to evaluate whether their particular technique is a good fit for the residents in a specific setting.
In conclusion, chiropractic care is a safe, effective, evidence-based approach to caring for older adult patients. Incorporating chiropractic services in the LTC setting may help offer patients less invasive options for the management of pain and functional health issues. In the midst of America's opioid epidemic, there is wisdom in including non-pharmacological management strategies, consistent with recent pain management guidelines.
Lisa Z. Killinger, D.C., is a member of the Foundation for Chiropractic Progress, a not-for-profit organization dedicated to increasing public awareness regarding the value of chiropractic care.
She earned her Doctor of Chiropractic degree from Palmer College of Chiropractic in 1983. She is currently a Professor and is the immediate past Director of Diagnosis at Palmer College.