You get your hair cut. You go for dental checkups. Why not take care of your back health this week?
It’s Chiropractic Awareness Week 8-14th April and we’d like to invite you and your family to benefit from a spinal health check and posture review, where we can offer some advice on how to care for your back. You can also find out how chiropractors can help you move better and feel better.
The World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” So what’s this concept of “wellness” all about? Well, wellness is basically healthiness… It’s the active process of becoming more aware of your health and making positive changes towards leading a healthier, more fulfilling life.
What is wellness?
The concept of “wellness” can often be a dirty word in healthcare circles, as it has long been associated with antiscientific or pseudoscientific ideas… But that depends on what wellness means to you. To us, wellness is health. It’s living a healthy and fulfilling life, and taking responsibility for your own health. We’re taking ownership of the word wellness and are going to strive to clean up its reputation!
Go on then, how?
As an evidence based clinic, we rely heavily on what research tells us is effective for managing conditions or symptoms, and as such the treatment protocols that we utilise can vary quite dramatically depending on what the latest high quality research says is effective. We don’t sell long treatment plans, and you shouldn’t buy into one either- it’s impossible to know that someone will need 12 treatments to get you better when they first start seeing you- instead, a short course of treatment should be proposed and that should definitely include a review appointment where you discuss your progress and determine if you should be discharged from care. We collect patient reported outcome measures to ensure that we do not over or under-treat our patients, and this provides us with an opportunity to identify how effective the treatment is that we’ve provided,
(P.S. We monitor how many treatments our patients receive on average- it’s just 5 appointments over a 3 month period!)
We promise you that as an ethical healthcare clinic we will never offer you ineffective, unnecessary treatment.
Why does wellness matter?
If you were lucky enough to be born in the UK, chances are you’ll have encountered the NHS once or twice. The NHS is a fantastic system for taking care of us, but it is overstretched, overburdened and not coping. When it was established in 1948, life expectancy for men was 66 years old, and for women, 71. Today those figures are 77.2 and 81.5. Over the past 60 years, the proportion of all deaths caused by cancer has risen, from 16.9 to 27 per cent. It took 50 years for the UK population to increase from 40 to 50
million between 1898 and 1948, but in just 24 years the population will increase by 10 million – and hit 70 million in 2029, according to the Office for National Statistics. Simply put, there’s more of us, we’re living longer, with more diseases and more complex health needs than ever before. Our poor NHS can’t cut it.
The NHS will always be there for us when we get sick- but how about we work a little harder to stop ourselves needing it in the first place?
More and more people are recognising a need to take responsibility for their own health and are striving to lead a healthier lifestyle. This can be through small steps, such as reducing your alcohol intake, not smoking, regularly exercising or you might take it a little further, with bespoke nutritional programmes, chiropractic care to optimise performance and move well, in addition to regular care to address the stresses and strains we put our body through on a daily basis.
An holistic approach to health
Ahh, “holistic”. Another dirty word. Or is it? Philosophically, holism is described as “the belief that the parts of something are intimately interconnected and explicable only by reference to the whole.” From a medical perspective, it’s characterised by “the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.” Doesn’t sound so bad to me- as humans we do need to consider the person as a whole. Someone with back pain doesn’t just have back pain- they have a problem that’s preventing them from going to work (social issue), that’s causing them anxiety (psychological issue), that’s limiting their ability to walk (physical issue) and no doubt a whole host of other problems. So it would be churlish to only consider the physical issues- that’s probably not going to get them truly better, particularly for those with high anxiety levels as there’s a whole host of research that tells us they need more specific management to help with their back pain. We need to acknowledge their
needs as a whole. We need to ensure we address all these aspects in order for them to recovery.
We also need to consider the why behind their pain. For example, a smoker will report higher levels of pain perception than a non-smoker. That’s an environmental issue. So an holistic approach would aim to tackle the smoking also (not least for the hundreds of health benefits you see from being a non-smoker) and encourage you to take active steps towards leading a healthier lifestyle (there’s that wellness
definition popping up again!)
This is what we aim to provide for our patients- not just addressing the physical symptoms but ensuring that all your health needs are met.
So when we talk about taking an holistic approach to wellness, that suddenly doesn’t sound like such a bad thing, does it?
We are beyond thrilled to announce we have been awarded the highly regarded Patient Partnership Quality Mark (PPQM) and Clinical Management Quality Mark (CMQM) from the Royal College of Chiropractors for the second consecutive occasion! This comes following a highly successful launch of our new premises in Palmers Road, marking the start of an exciting new period for us.
The PPQM is awarded to clinics that demonstrate excellence in meeting patient expectations in a range of areas including accessibility, cleanliness and safety and patient communication. The CMQM is awarded to those clinics that demonstrate excellence in terms of operating within a structured and managed clinical environment. The clinics must demonstrate excellence in a range of areas including clinical audit, incident reporting and patient satisfaction.
Philippa comments “We are thrilled to have been recognised by the Royal College of Chiropractors for the second consecutive occasion. Acorn Health began trading in 2014 and expanded to new premises just last month, so we’re delighted to have achieved this recognition in a relatively short period of time. We want our patients to receive the very best care we can offer, and we’ve worked hard to ensure we meet the high standards set by the Royal College of Chiropractors and deliver on all aspects of both patient care, service and clinical excellence.”
The decision to award the Quality Marks is made by a panel of patients and public who form the Royal College of Chiropractor’s Lay Partnership Group. In being selected to receive both Quality Marks, Acorn Health has become one of less than 50 clinics in the UK to hold both awards. Philippa comments “It’s a huge honour to have been selected to receive both awards once again, and is a testament to the level of service provided by all of the team here that we have met these high standards of excellence.”
The treatments and services we provide at Acorn Health are uniquely tailored to your needs, and it is important that we work together with you to achieve whichever end goal you are seeking- be this reduced pain, improved sporting performance, or simply being able to run around with your family!
Our wonderful team of practitioners work together to support each other and you, ensuring your and your family’s healthcare needs can be met under one roof.
We’re not talking about the BBC PROMS, or in fact anything to do with music. We’re talking about Patient Reported Outcome Measures (PROMs), and they’re far more exciting than the BBC version (in our humble opinion).
Patient Reported Outcome Measures are the tools with which healthcare practitioners and clinicians can better understand the impact illnesses or conditions and treatment are having on our patients’ daily lives. At Acorn Health, we utilise Care Response, a system which gathers the data for us and is supported by the Royal College of Chiropractors.
We don’t collect PROMs purely for our own benefit, it’s also for yours. We want to understand how your pain or problem is affecting your daily life- are you able to wash and dress yourself without pain? Is it stopping you from having a social life? Is it preventing you from working? Not only that, but we want to know how you feel about your pain. Are you worried it’s never going to get any better? Perhaps you’re scared about whether being physically active is going to make it better or worse and had to duck out of that golf game you had lined up. These are all very common concerns (so don’t worry if you’re having them- we all do!) and by understanding what your concerns are and how your pain is affecting you, we can provide a more accurate and more appropriate course of treatment for you. The responses to these questions will also indicate to us whether you are at a low, medium, or high risk of the problem becoming chronic (lasting for a long time) and this can mean that we need to provide you with very specific advice and information in order to prevent this happening- and yes, it can be done!
PROMs are starting to sound really good, aren’t they?
Another fantastic thing about PROMs is that they can tell us whether the treatment plan we have together decided upon is having the effect we want or not. Often, when pain decreases it can be difficult to remember just how bad it was (Remember that saying about giving birth? If we remembered how bad childbirth was we’d never have more than one child!) That being said, PROMs give us a way to determine your response to treatment based on your original responses to the questionnaire.
The story of patient X: Utilising PROMs in clinical practice
So how do we put PROMs to use in clinical practice, and how do they help inform our decision making and improve the care we provide our patients? We’ve got a case study here to explain it.
A bit of background- this Patient (let’s call them Patient X… sounds all mysterious and technical doesn’t it!) Anyway, Patient X had sustained a lower back injury in a road traffic accident more than a decade ago and had suffered with recurring episodes of lower back pain which, as seen by the chart below, were having a significant impact on their ADL’s (activities of daily living- things like washing, doing housework and sleeping) as well as their social life (going out to see friends, going to the gym, playing sports), the pain was a 6/10 and it was also making them anxious, depressed, having quite a severe impact on their working day and they had very little ability to cope with, control or reduce the pain themselves. All in all, not a very pleasant situation to find yourself in, but these results are fairly common in the patients we see in clinic. So much so, in fact, that Philippa takes a special clinical interest in chronic pain management– but that’s a story for another time.
The questions on the initial form are part of a validated assessment tool called the Bournemouth Questionnaire, and the answers are scaled on a 0 – 10 linear scale, 0 being “the pain has no interference” and 10 being variations of responses such as “completely unable to carry on” or “extremely anxious/extremely depressed.” As you can see, this patient was also at medium risk of chronicity due to some concerns they had about their back pain and what it meant for them, as they were worrying about it a lot of the time and felt that it was never going to improve.
We normally complete an outcome questionnaire after 2 weeks but in this particular case it was after 4, and Patient X completed this questionnaire which asked how their pain has changed, and also assesses the impact this pain is having on their lives at that time. This is where we get a bit geeky and excited- bear with us while we explain why.
Yes, as you can see below, Patient X’s pain level had increased at the time they completed the outcome questionnaire because (by their own report) the “Sciatic nerve in left leg has been irritated since last weekend” after spending a weekend doing a lot of heavy work in the garden…. they knew it wasn’t the best idea (!) However, despite the fact that they’d been doing quite hard physical work and had a slight flare-up as a result, they still reported they were “much improved” as a result of treatment, and their Bournemouth Questionnaire (the one that tells us how the pain is impacting on your day-to-day life) had reduced from 52/100 to 34/100 (which is computed as a 34.62% improvement!)
How is it possible that the pain could actually have increased, but Patient X felt better? Well, as we do with all our patients, we had a lengthy chat with Patient X about their pain, and how it was impacting them, and how they could manage it more effectively, as well as what we could do to help. Studies have shown that in some specific cases, a pain management course is actually more helpful than physical treatment, so we always include pain management as part of our treatment programmes. The more control you have over your pain, the less pain you feel. So through understanding pain and knowing what’s going on, what the cause was (in this case a mechanical issue with how a joint in the lower back was moving) what it isn’t (lower back pain is very rarely serious) and what to do about it (treatment and active self-management), Patient X felt less pain as they were less threatened by it, understood what was going on, were less concerned by the pain and able to move more normally without fear of pain.
After speaking to Patient X to establish what they felt had changed, the overall message was “I know what’s happening now, and I know what to do about it.” Woohoo! This is why it’s absolutely critical that we convey the right messages to you and help you to understand your pain. As practitioners, we also know that pain in itself is a really unreliable indicator of the severity of the underlying issue. To use our favourite analogy- think how painful a papercut can be despite the fact it’s a fairly minor injury. Pain in itself is just a symptom and studies have shown it does not relate to the severity of the underlying problem- in fact, some studies show that pain related fear is more disabling than the pain itself!
To understand more about pain and what causes pain, this should be your next bit of reading: Understanding Pain.
Let’s get back to Patient X, who today completed their final outcome assessment.
As you can see, the pain has dropped now to a 3/10. Those sections where Patient X reported were a 9/10 (ability to complete ADL’s and impact on social life) have dropped to a 3/10 and 2/10 respectively, impact on work was initially 7/10 and is now 0/10, anxiety and depression are both down from 7/10 to 1/10, and ability to cope with, control and reduce the pain was initially a 7/10 and is now a mere 2/10!
Whilst plenty of naysayers might say “Sure, but they’re not pain free and their Bournemouth Questionnaire isn’t zero.” If you had an illness or disease that lasted several years, would you take a few pills and expect it to be cured? No. Realistically, you’d hope that it would be better, as it is for this patient. Recovery takes time and is something that cannot be rushed. If you recall, Patient X’s problem had started over a decade ago, so we’re delighted that two months later the pain has improved this significantly. Not only that, but Patient X reports feeling “much improved” as well so we know they’re happy with how they’ve progressed- which gives us all sorts of warm fuzzy feelings. Hooray for job satisfaction!
So what happens now? At this stage, we’ll see a lot less of Patient X as they are formally discharged from care. The pain is now so minimal and intermittent that after discussing it with them, they’re happy to manage it themselves at home with stretches, exercises and lifestyle modifications (such as taking regular breaks from sitting whilst at work). We’ll check up on them in a few months to review their exercises, identify if there are any issues that have crept back on and this also gives us an opportunity to discuss their progress with them and if they have any further concerns. Of course, we’re always at the end of a phone or email, Facebook, Google+ or Twitter if they (or you) want to get in touch in the meantime!
We never guarantee 100% cure as nothing in medicine can. No pill, no operation, no treatment. There are no guarantees. What we do say at Acorn Health is that we will always give you the very best treatment and care, in accordance with the latest research guidelines and current evidence base. We can also say (thanks to another fancy PROMs questionnaire) that we have 100% satisfaction rates from every patient we’ve seen since we opened back in 2014, and that makes us very happy indeed.
So there’s a little overview and case study into how PROMs are put into use in clinical practice, and why we utilise them! If you’d like to know more, or would like to get in touch to book your own appointment, you can contact us using the form below.