PT In The ER & Back Pain And Mortality

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 352: PT In The ER & Back Pain And Mortality Today we’re going to talk about PT In The ER & Back Pain And Mortality But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #352 Now if you missed last week’s episode, we talked about Guides Treating Non-specific Low Back Pain & Pain-Catastrophizing With Chronic Pain. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Welp, October is wrapped up and here we are in November already. Time change and everything. Except for our brethren in Arizona who are basically geniuses for not going along with the rest of the idiots that are still changing time twice per year. Why is that still a thing? This time change is fine because we gain an hour of sleep but it’s dark when we get out of work for 4 months. And that makes for a bitchy, Jeff. I’m just saying. In the Spring, when it changes back to a sane time, how about we just leave it for once? Maybe that’s just too much to ask. Business, we did great in October. Except for collections. Remember, clinic ownership is a game of whack-a-mole.

Over and over.

As soon as you get problems fixed, something else will pop its head up. Last month, it was collections. The month before, back in September, we collected about a third more than our overhead. Maybe even more than that. In October, we knocked it out of the park on our stats. Patient visits, new patients, billing, the whole thing. Except for collections which might have covered our overhead. Maybe. It’s so damn frustrating. This is yet another reason that you have to leave some gas in your tank. You cannot control collections.

Especially if they’re off-site, which ours is off-site. One of our billing clearing houses had some sort of computer glitch two weeks ago and is still clearing it up. Well, we don’t have a bit of control over that. Unless we chose to go cash. Which I’m scared to death of because I’m a terrible salesperson. I didn’t get into this to sell. I got into it to heal. Anyway, if I didn’t leave gas in the tank and have reserves, and this glitch continues, we’d really start to worry about payroll this Friday, right? But, the work was done, it’s out there.

We just gotta get it. And in the meantime, we have reserves to cover us until we can get it. Other than that, the new medical team is up and running and really settling in here at the clinic and getting comfortable. It’s always difficult to get new providers started and up and running but we’re on it. Whack-a-freaking-mole. Embrace it and lean into it because that’s the way of life for a clinic owner. If you’re an employee and you don’t own it, you’re good. Enjoy your life. If you’re the owner, lean into it and give whack-a-mole an inappropriately long hug because you better get comfortable and get to know each other very well.

Item #1 Our first one this week is called, “Advanced Musculoskeletal Physiotherapists Are Effective and Safe in Managing Patients with Acute Low Back Pain Presenting to Emergency Departments” by Sayer et al and published in the Australian Health Review in June of 2018. Remember, the citations can be found at chiropracticforward.com under this episode.

Sayer JM, Kinsella RM, Cary BA, Burge AT, Kimmel LA, Harding P. Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments. Aust Health Rev. 2018 Jun;42(3):321-326. doi: 10.1071/AH16211. PMID: 28538139.

Why They Did It

The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-advanced PT clinicians (ED doctors and nurse practitioners).

How They Did It

A retrospective audit was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by advanced PT and non-advanced PT clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED.

What They Found

One thousand and eighty-nine patients with low back pain were seen during advanced PT service hours (360 in the advanced PT group, 729 in the non-advanced PT group). Patients seen by the advanced PT had a significantly shorter ED wait time and ED length of stay. Significantly fewer patients seen by the advanced PT were admitted, and this difference remained after accounting for the difference in triage code between the groups.

Wrap It Up

Improved ED metrics were demonstrated in patients with low back pain when managed by an advanced PT compared with patients seen by doctors and nurse practitioners. There is a growing body of literature regarding the role of advanced PTs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. advanced PTs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes.

Item #2

Our last one this week is called, “Association of back pain with all-cause and cause-specific mortality among older men: a cohort study” by Roseen et al and published in Pain Medicine in August of 2024 and schiza it’s hot to the touch!

Eric J Roseen, David T McNaughton, Stephanie Harrison, Aron S Downie, Cecilie K Øverås, Casper G Nim, Hazel J Jenkins, James J Young, Jan Hartvigsen, Katie L Stone, Kristine E Ensrud, Soomi Lee, Peggy M Cawthon, Howard A Fink, for the Osteoporotic Fractures in Men (MrOS) Research Group, Association of back pain with all-cause and cause-specific mortality among older men: a cohort study, Pain Medicine, Volume 25, Issue 8, August 2024, Pages 505–513, https://doi.org/10.1093/pm/pnae040

Why They Did It

They wanted to evaluate whether more severe back pain phenotypes—persistent, frequent, or disabling back pain—are associated with a higher mortality rate among older men.

How They Did It

In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, they evaluated mortality rates by back pain phenotype among 5,215 older men from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death.

What They Found

After the Year 5 exam, during up to 18  years of follow-up (mean follow-up = 10.3 years), there were 3,513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died. No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions. Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models.

Wrap It Up

Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. And there you have it. It makes sense that if back pain has you disabled, then lack of movement, activity, and function would lead to increased mortality, no? Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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