Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1094
Narratives 88 N

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"What Should I use for Functional Assessments?"

 

Dr. Studin: what's the issue?

Guest Doctor: So, my question is what is the best functional outcome assessment to use?

Dr. Studin: Okay, here's the answer. A lot of doctors are using Oswestry neck pain index, back pain index and before I answer that question, you have to understand what those tools are and what they were meant for. Those are population-based studies or algorithms, computer program, but it was created that way for work related issues, labor statistics. So, what they do in Oswestry is you get a score and like 64 to 180 out of 100 and they'll take a million or two or 3 million people and they'll find a mean of what normal should be. Here's the problem. Oswestry specifically does not take whole person into account.

Now, for instance, say you're looking, that'll take the actual injured account or look at a whole person. Now, for instance, if you're a concert pianist and you lose the use of your index finger, you've just lost 100% of your ability to function. But if you're, if you're a psychiatrist and you lose your index finger, well, no big deal that doesn't affect your ability to function. The other thing is, is in that population-based study, you could have 50% of the population, far left and 50% of the country far right.

What does that do with the person in the middle and has nothing to do with them? You know, it's kind of like politics into these environments. You could be an ultra-liberal and an ultra-conservative. Where does it leave the majority of the country? Nowhere. We're a lost, because we have no one that really, you know, so you understand what I'm saying?

Guest Doctor: Yeah, absolutely.

Dr. Studin: You got To make it real for your patients. So, I don't particularly care for those studies. Here's what the courts have actually weight on what's appropriate and they did a really good job and colossus actually weighed in and colossus did a good job. And the answer is, Mrs. Jones used to be able to carry her child for an hour before her injury. Since her injury, she can only carry it for five minutes, but after four months of care, she can go back and carry her baby now for 45 minutes. And she's doing that much better. But there's still residuals. Keep it real.

Now, in certain managed care companies, they require you to do an Oswestry. And then in that particular case, you must comply with their requirements. So, you want to get paid. But by the same token, keep it real.

Guest Doctor: so still keep it real but just the insurance carrier requires it.

Dr. Studin: You have no choice. You have zero choice. Now I've created a for everyone, and I did this a few years ago and actually hired a company to do all the graphic work on. It was really cool. It's a functional assessment of your patient and it breaks it up into the five colossus categories because again, colossus has got it right. It's work, school inside the house, like dishes, you know, changing the sheets outside the house, like mowing the lawn and all those other things. And then it gets into academic work academics than social, which includes sports, dancing, theater, church sports, etc.

Guest Doctor: grooming's inside the house.

Dr. Studin: Not that. Inside.

Guest Doctor: Gotcha.

Dr. Studin: Okay. So, that's what you really should do. And then that will resolve that issue. Okay?

Guest Doctor: Okay, awesome. Thank you. Bye.

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