Evidence-Based Medicine - What does that mean?
by Dr. Brian S. Seaman, DC, FRCCSS(C), FICC

"Evidence-based medicine", or 'EBM' - likely a term that many of you are not familiar with. However, nowadays in any field of health care, it is a commonly used adjective. The concept is that treatments should be proven to be appropriate and effective with research. But studies that are large enough to be statistically relevant can be very expensive and time consuming. It is important when doing such research, that the methodology selected is also appropriate for what is trying to be proved.

EBM attempts, through appropriate research protocols, to establish 'gold standards'; or in other words the best way to treat a certain condition. But there are many treatment approaches that as health care professionals, we know work very well. However the financing, staff and population base is not always available, especially for conservative treatment approaches such as chiropractic.

Despite the limitations with research, there have been numerous studies published over the past 35 years that clearly demonstrate the effectiveness and cost-effectiveness of chiropractic care; in particular with lower back pain. Such research dates back to 1970 (California Work Injuries, State of California Department of Industrial Relations, Devision of Labour Statistics and Research) and through the years similar statistics have originated from studies (many of which used WCB statistics) in Oregon (1971 and 1975), Iowa (1978), Montana (1978), Wisconsin (1979), Saskatchewan (1985), Quebec (1986), Britain (Meade Study, 1990 and 1995), and Australia (1992). In addition there continues to be research published on a regular basis which have demonstrated the benefits of chiropractic care including a study by the US Military (Birch and Davis 2000); Workers Safety Insurance Board (Ontario, 2004); Archives of Internal Medicine (October, 2004); British Medical Journal (November 2004) and the Journal of Manipulative and Physiological Therapeutics (January 2005).

With the Workers Compensation Board of Nova Scotia, the number of claims over the past 10 years that are the result of back injuries, has not varied much; approximately 32 to 33% per year on a consistent basis from a low of 31.9% (1994, 2002 and 2003) to a high of 33.3% (1999). (Source: WCB Annual Reports). Chiropractic care has been shown to get injured workers back to work sooner, and with less cost than with other approaches. One such example used data from the Australian state of Victoria. This study (1992) reported a 58% cost savings per claim, a 75% reduction in compensation days and significantly less cases (by 6 times) which progress from an acute to chronic injury (defined as incapability due to injury for more than 90 days). (Source: Mechanical Low Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme", Phillip S. Elirall, Chiropractic Journall of Australia (June 1992) 22(2): 47-53).

Think of how many friends, acquaintances, family members or people you know in the neighbourhood, who have lower back pain. Likely quite a few - right! Lower back pain is generally considered to affect up to 80% of the population, to a significant degree, at some point during our lives. Being that the majority of lower back pain cases are considered mechanical (ie. how the joints move and the muscles work) chiropractic is a treatment approach that should be seriously considered by all lower back pain sufferers.

A chiropractor will review the history of your back problem, examine the area, determine the cause (or potential causes) and recommend the appropriate treatment. If chiropractic treatment is indicated, this will usually include spinal manipulative therapy or 'adjustments', as well as a variety of soft tissue and muscle therapy techniques or modalities (ie. ultrasound, muscle stimulation, etc). The vast majority of patients are also prescribed exercises to strengthen the supportive muscles and to maintain their flexibility. As an example, patients with chronic lower back pain, are often prescribed exercises with a view towards increasing the strength of what are referred to as the core muscles.

Chiropractic is a lot like dentistry - depending upon your lower back condition periodic check-ups may be recommended. Just like your dentist advises you to floss, brush and rinse daily in order to maintain good oral hygiene, your chiropractor will encourage you to maintain a healthy lifestyle by watching your weight and being diligent with your prescribed exercises. Extra body weight can put additional strain on your lower back as well as your heart.

It has been my clinical observation that only a small percentage of people actually keep up with their exercises on a regular basis for more than a few months. It seems a patient's interest and diligence with their exercises seems to be directly related to their level of pain and restriction in their daily activity level. But that is human nature!

So what does this all mean? It means that keeping your weight down and exercising regularly helps your heart, your back and your health in general. And if you experience lower back pain, consult with a chiropractor - that is 'evidence-based medicine'!

Reprinted with permission of
The Seniors' Advocate. P.O. Box 5005, Waverly, Nova Scotia, B2R 1S2

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