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Friday, November 03, 2017

VA Residents Attend North American Spine Society’s Annual Symposium

Part of a series on the chiropractic residency program in the VA health care system

By Steven Huybrecht, DC

In late October, three of the five chiropractic residents within the Veterans Administration (VA) health care system attended the North American Spine Society’s (NASS) annual symposium in Orlando, Fla. Rachel Mooers from Los Angeles, Stephanie Halloran from West Haven and I spent four days immersing ourselves in spine care from a (mostly) different perspective.

The conference, held Oct. 25-28, was dedicated to the advancement of global spine care through research, abstract presentations, interdisciplinary forums and more. Attendees from a multitude of professions, including orthopedists and neurosurgeons, physiatrists, anesthesiologists, chiropractors, physical therapists and medical students, convened to expand their knowledge. I’ll share some of the information presented, personal experiences from attendees and overall takeaways from the weekend.

Stepping Out of My Comfort Zone

First, having never before attended a NASS conference, I felt a little out of my element, but I was fortunate to share this new experience with the other residents and a couple of chiropractic students. We made our way around the massive Orange County Conference Center, deciding what topics looked interesting and specifically choosing some that were not “in our wheelhouse.” The purpose of attending this conference wasn’t to reinforce or propagate what we already knew about the spine, but to see things from a different viewpoint. With a membership comprised of approximately 50 percent orthopedic surgeons, 25 percent neurosurgeons and only 1 percent chiropractors, we were definitely in the minority. However, I found it refreshing because it can be so easy to stay in our own silos and approach a particular topic the same way over and over. Real growth happens when a person steps outside of their comfort zone.

Arriving around noon on the first day of the conference, I attended a leadership session based on the DISC method, which groups people into four personality types: Driver, Innovator, Socializer and Connector. We filled out a brief questionnaire, tallied our score for each category and were shown an overall picture of where we landed on the spectrum. The purpose of this was to learn how to approach different personalities in a professional setting (or in life), whether they are your staff, colleagues or patients. We rounded out the day learning about how inflammation, movement and biopsychosocial factors contribute to low back pain.

The following day started early with an interdisciplinary forum titled, “Restructuring and Integrating Spine Care.” This proved to be interesting for multiple reasons, one of which was the inclusion of four chiropractors in the discussion and another being a heavy focus on spinal manipulation. Rob Russell, DC, moderated, while Christine Goertz, DC, discussed the need to improve value in spine care. Ian Paskowski, DC, and Steven Passmore, DC, reviewed how to reduce costs and improve outcomes through evidence-based models, including the VA model. Dr. Passmore keenly suggested that those in attendance should look at integrated models such as the VA when hiring a chiropractor as part of their team. Jonathan Free, a chiropractic student at Logan University attending the symposium, noted, “My favorite part was the emphasis on having a team approach. This conference really opened my eyes to the direction that health care is headed as a whole.”

One of the afternoon sessions reviewed controversies in low back guidelines. The purpose of this talk was to discuss how guidelines often fall short of providing useful clinical practice recommendations and how virtually none of them consider subgrouping patients. Tools and methods of subgrouping to provide better outcomes were then offered. A town hall meeting then followed with the NASS leadership reviewing goals for the coming year and fielding questions from the audience. An interesting note was that NASS was working toward legislation regarding “travel to treat” for sports medicine providers, which is something the American Chiropractic Association (ACA) has also pursued. I think this highlights an opportunity for collaboration between ACA and NASS, as well as an opportunity for chiropractors to become more involved in NASS. In fact, there appeared to be many overlapping themes between the two groups.

Chiropractic's Value in Team-based Care

Stephanie Halloran and I rounded out Thursday at a reception for residents, fellows and program directors. We met a handful of orthopedic surgeon fellows and soon were discussing our educational experiences. They were receptive to chiropractic and some of them were even working with chiropractors, including one from Duke University.  Stephanie commented, “My favorite part was when they asked what we considered a contraindication to cervical traction because they felt we would know better than they would.” I think this highlights the need for team-based care to share knowledge on a given subject.

Friday was packed again with educational sessions, beginning with a talk about producing high value care, which appeared to be one of the themes of the symposium. Following that was the women’s forum, moderated by Gregory Whitcomb, DC, with topics focusing on gender differences in relation to pain. One of the most interesting points was that many of the items we use in society, from bicycles to keyboards to footwear, often aren’t well designed for women, which can lead to increases in spinal pain.  The final session before lunch focused on causes, treatments and outcomes for people with spinal stenosis. Interestingly, single-level decompression surgery displayed greater outcomes than multi-level decompression.

The afternoon was highlighted by an interdisciplinary forum, which examined military injury, biomechanics and engineering. This was fascinating because we learned about spinal injuries sustained in military environments and how these differ from civilian automotive environments due to unique biomechanical loading scenarios.  One of the most interesting parts was watching simulations of under-body blasts of Humvees, ejections from fighter jets and a helicopter crash. Due to the different stressors placed on the body in these unique experiences, injury and pain often result. Rachel Mooers commented on the collaborative effort of the symposium saying, “With so many points of view, egos could have easily fogged the ultimate goal of improving patient care and finding solutions to disparities in spine care, but this didn’t happen.”

The symposium wrapped up on Saturday with a few sessions before noon. In a talk titled, “Empowering Your Patient,” members of the American Chronic Pain Association covered an applicable and interesting overview of self-management.  A variety of management options were discussed, and while chiropractic was not specifically mentioned in the therapies that could be beneficial, spinal manipulative therapy was listed. This could provide an opportunity to educate the ACPA (and other health care professionals and organizations) about what chiropractic has to offer in terms of pain management and how we also utilize self-care in our treatment plans.

Ready to Step Up to the Plate?

Overall, attending NASS was a great choice for many reasons, and I encourage more chiropractors to consider attending next year’s symposium in Los Angeles, which will be held from Sept. 26-29.  As attendees, we gained an appreciation of how other providers approach spine care, learned about medical fellowships, and were shown unique considerations for specific populations. Some of the overarching themes included a push toward value-based care and increased collaboration amongst providers. We as chiropractors can provide relief from an overburdened health care system while increasing outcomes and reducing costs. The way to create the greatest impact will be through collaboration and more doctors of chiropractic working in team-based settings such as hospitals, patient-centered medical homes and accountable care organizations. A great opportunity is present; it’s up to us to step up to the plate and take it.

(L-R: Rachel Mooers, DC, – Los Angeles VA Chiropractic Resident, Steven Huybrecht, – St. Louis VA Chiropractic Resident and Stephanie Halloran, DC, – West Haven, Connecticut VA Chiropractic Resident) 

Dr. Huybrecht is the chiropractic resident at the VA St. Louis Healthcare System under program director Pamela Wakefield, DC.  He is working toward completion of the Certified Chiropractic Sports Physician program and certification in chiropractic acupuncture. Dr. Huybrecht’s professional interests include chronic pain management for veterans, organizational leadership, and state and national advocacy.  

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