Welcome back to Spine IQ’s Back Blog! Our theme for the month of March is Getting Back Better, with a focus on evidence-based resources to mitigate the impact of the COVID-19 pandemic on clinical care for spine-related conditions. Join us throughout the month to learn about the practical applications of telehealth, what you can do as a provider to educate your community about spine care during a pandemic, and how to best protect your patients in clinical setting. The best part? We will conclude this series with the webinar “Getting Back Better” hosted by Spine IQ CEO Dr. Christine Goertz and featuring special guest Dr. Scott Haldeman. Mark your calendar now for April 6, 2021 at 6 pm ET and follow us on our social media platforms for further details!

In June of 2020, a survey of 750 U.S. chiropractors found that over half of respondents reported moderate levels of stress (rated 4-7 on scale 0-10) associated with the COVID-19 pandemic, primarily relating to financial and business concerns.  In addition, nearly three-quarters of physical therapists reported revenue losses that exceeded 50% at some point. Hopefully soon the worst of the pandemic will be in our rearview mirror. Full resolution of the issues causing clinicians stress last year will take longer and, in many ways, our world has been forever changed. Spine IQ is here to help you navigate this new world, providing the evidence and tools you need to treat patients confidently – both in person and “off the table” via telehealth.

By the summer of 2020, 18% of chiropractors (survey) and 13% of physical therapists (report) had begun offering telehealth services. Our health policy colleagues tell us this trend is here to stay across provider types and health systems. Unfortunately, spine care by Zoom is not something many of us learned about in our professional educational programs! However, you don’t have to figure out best telehealth practices on your own. Recent guidelines developed jointly by the Global Spine Care Initiative (GSCI) and World Spine Care (WSC) provide guidance to both patients and clinicians regarding when telehealth is an appropriate platform for care. For example, reassurance and advice on evidence-based self-care strategies can be delivered via video visits (1) and may be effective in managing painful symptoms (2) in patients with low risk of progressive symptoms.

Another option to consider is taking a community-based perspective to patient care by using social media. Posting high-quality educational content to social media platforms like Facebook, Instagram and Twitter allows you to direct existing and potential patients to trustworthy resources and neutralize misinformation (3). Additionally, the GSCI/WSC guidelines recommend providers develop a library of publicly available evidence-based educational materials that can be sent directly to patients via email or text message. We’ve included some resources below for you to get started!

With proper instruction from a conservative care clinician via video consultation patients can utilize self-management techniques to effectively manage symptoms from the convenience and safety of their home (4, 5). These range from teaching prescriptive stretches or exercises to instruction on how to perform self-massage using household items like a tennis ball. Additionally, clinicians can offer specialty services to patients such as performing a virtual ergonomic evaluation of home workstations or assisting with postural awareness. Finally, patients can be advised on a broad range of lifestyle choices that impact stress management, sleep, diet, or daily activities that may trigger painful symptoms.

Want to know more? Join us next week when we focus on how to do a virtual exam!

Examples of Free Educational Materials Available Online:
Spine IQ BACKfacks 
NCCIH Health Information (A-Z List of Complementary Health Products and            Practices)
Self-Guided Cognitive Behavioral Education Program 

1. Geenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for covid-19: an opportunity in a crisis?. BMJ 2020;368:m998.

2. Haldeman S, Nordin M, Tavares P, Mullerpatan R, Kopansky-Giles D, Setlhare V, Chou R, Hurwitz E, Treanor C, Hartvigsen J, Schneider M, Gay R, Moss J, Haldeman J, Gryfe D, Wilkey A, Brown R, Outerbridge G, Eberspaecher S, Carroll L, Engelbrecht R, Graham K, Cashion N, Ince S, Moon E. Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative. JMIR Public Health Surveill. 2021 Feb 17;7(2):e25484. doi: 10.2196/25484. PMID: 33471778.

3. Eccleston C, Blyth FM, Dear BF, et al. Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. Pain. 2020 May;161(5):889-893. DOI: 10.1097/j.pain.0000000000001885.

4. Rini C, Porter LS, Somers TJ, McKee DC, DeVellis RF, Smith M, Winkel G, Ahern DK, Goldman R, Stiller JL, Mariani C, Patterson C, Jordan JM, Caldwell DS, Keefe FJ. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. PAIN 2015;156:837–48.

5. Dear BF, Gandy M, Karin E, Staples LG, Johnston L, Fogliati VJ, Wooton BM, Terides MD, Kayrouz R, Perry KN, Sharpe L, Nicholas MK, Titov N. The Pain Course: a randomised controlled trial examining an internet-delivered pain management program when provided with different levels of clinician support. PAIN 2015;156:1920–35.