1. Efficacy and Effectiveness of Chiropractic Care A Compilation of Findings With Special Commentaries © Copyright 2014 Workplace Human Relations. All rights reserved. Sit back, relax, learn. Slides advance @ 15 seconds. Or, use keyboard arrows to advance forward-backward through slides. Total time estimated at 4 minutes. (Time well spent.)

2. About Chiropractic: Non-invasive, drug-free, conservative approach “No-disability mindset” (work is therapeutic) Earlier return to work of injured worker High level of patient satisfaction Education grounded in: biomechanics, anatomy, musculoskeletal system, wellness, fitness, diagnosis/treatment, and clinical management Doctor of Chiropractic degree requires 4800+ basic chiropractic education (slightly more than family practice doctor education) Annual continuing education hours requirements

3. Is Drug-free Important? Between 2001-2008 drugs (largely narcotics) prescribed for workplace injuries rose 63%. In a review of claims *, it was found the typical work injury payout was $13,000. When shorter term (narcotic) painkiller is prescribed, the cost can triple; when a longer term (narcotic) painkiller is prescribed, the cost can be as much as nine times higher. - Meier B. “Pain Pills Add Cost and Delays to Job Injuries.” The New York Times, June 2012. * Accident Fund Holdings

4. Is Drug-free Important? In 2010, an alarming number of people, to be exact, 16,651, died of opioid overdose in the United States. For every 1 opioid-related fatality, there are more than 150 individuals who are either abusing or are dependent upon opioid use. - Center for Disease Control and Prevention (CDC) 2010 - CDC’s report, CDC Grand Rounds: Prescription Drug Overdoses: a U.S. Epidemic (2012)

5. Reduced Costs: Study (52 weeks): 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs). Clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one- third of the costs of physiotherapy or general practitioner care. -- Korthals-de Bos et al (2003), British Medical J.

6. Manual Therapy Scores High: “…randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures…” – Hoving et al (2002), Annals of Internal Medicine

7. Reduced Work Absences: “…Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.” – Hoving et al (2002), Annals of Internal Medicine

8. Preventing Disability: LBP In a study of 894 cases, aimed to “study the association between provider type during the initial period of return to work and risk of recurrence of disability due to work-related LBP… “Conclusions: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.” Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence. Manuel Cifuentes, MD, PhD, Joanna Willetts, MS, and Radoslaw Wasiak, PhD, MA, MSc

9. Gatekeeper for MSDs: "Reduced odds of surgery were observed for...those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor." – Keeney et al (2012), Spine

10. Job-related Back Injury: Study of 10,652 back injuries occurring at work, of those getting chiropractic care (compared to medical care): - 51.3% had shorter total disability duration; - Had 58% lower treatment costs ($558 versus $1,100/case; - Had lower hospitalizations (20.3% versus 52.2%)." – Wolk S. An analysis of Florida’s workers’ compensation medical claims for back-related injuries. J of American Chiropractic Association, 1988;27(7):50-59

11. Therapy Without Meds: 272 participants divided in three groups received either spinal manipulative therapy from a doctor of chiropractic (DC), pain meds (OTC pain relievers, narcotics, muscle relaxants) or exercise recommendations. After 12 weeks, 57% of those who met with DCs and 48% who exercised reported at least a 75% reduction in pain, compared to 33% of the people in the medication group. After one year, approximately 53% of the drug-free groups continued to report at least a 75% reduction in pain; compared to just 38% pain reduction among those who took meds. -- Bronfort et al. (2012), Annals of Internal Medicine

12. Chronic Low Back Pain: “Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.” – Nyiendo et al (2000), J. of Manipulative and Physiological Therapeutics

13. Chronic LBP: Cost of Care “We found that episode cost of care for LBP initiated with a DC is less expensive than care initiated through an MD. Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient’s costs, we found that episodes of care initiated with a DC are 20% less expensive than episodes initiated with an MD. Our results suggest that insurance companies that restrict access to chiropractic care for LBP may, inadvertently, be paying more for care than they would if they removed these restrictions.” – Liliedahl et al (2010), J. of Manipulative and Physiological Therapeutics

14. On-site Chiropractic: Bottom Line Insights Employees may use fewer health care resources Employees remain at work, then back to the job Chiropractic addresses neuro-musculoskeletal injuries Employees can discuss nutritional/dietary, exercise/fitness, and other concerns for rapid and immediate feedback Healthier employees absolutely impact higher quality output and productivity Onsite chiropractic creates an active wellness culture Employees accessing onsite care lead to a more positive work environment Onsite care supports reduced absenteeism

15. On-site Chiropractic: Injury Prevention as a component to the company’s wellness program can be relied on for short-term return on investment Onsite chiropractic care plays a role in early detection, disease management, employee health, injury prevention

16. On-site Chiropractic: Onsite chiropractic lends greatly toward employee retention and speaks well of your company’s commitment to safety and health Onsite chiropractic can be a very affordable option for small to medium size companies that otherwise could not afford onsite care for employees Consider that costs for prescription meds, radiology, surgery, disability, lost work days – all of these potentially may be reduced

17. On-site Chiropractic: In a study to determine the influence of on-site chiropractic care on healthcare utilization and associate-reported outcomes, findings “confirm that on-site chiropractic services are associated with lower healthcare utilization and improved functional status of musculoskeletal conditions.” Krause CA, Kaspin L, Gorman KM, Miller RM. Value of chiropractic services at an onsite health center. J. of Occupational and Environmental Medicine, in press, 2012.

18. On-site Chiropractic: Onsite chiropractic services is a powerful way to counter the costly problem of over-exertion type injuries resultant of material handling activities as lifting, moving, transporting, bending, twisting, pushing, pulling (over-exertion injuries alone costs $13 billion annually in the U.S.*) * Source: Liberty Mutual Insurance, Workplace Safety Index report

19. Services for Workplace: Injury Prevention in Material Handling Training Onsite Chiropractic Care Ergonomic Evaluations/Recommendations Substance Testing & Education for Workers, Supers, Management D.O.T. and/or Post-job-offer Physical Examinations Fitness Examinations Early Detection/Intervention (for Low Back. Musculoskeletal, RMIs, etc.) Diagnosis, Treatment, Rehabilitation for Injured Workers Return to Work Examinations Worksite Wellness, Disease Management Loss Data & Injury/Illness Stats Review/Consultation Work Station Analysis Worksite Hazard Identification Job Analysis (identify physical, emotional, cognitive demands of job) Cost Containment Consultation Advisory to Safety Teams Independent Medical Examinations

20. © Copyright 2014 Workplace Human Relations. All rights reserved. THANK YOU!