In The News
Dr. Kenneth Cohen, MD, FACP, Chief Medical Officer talks about designing evidence-based spine care
The current model of spine care is seriously flawed. It does not provide adequate clinical outcomes for a large portion of patients. Moreover, for most patients it is a “passive system” that does not actively engage them in their own rehabilitation to help assure long-term success.
Many of the services provided to patients with spine disorders do not have a high-quality evidence base to support the interventions being utilized including the following:
- Overreliance on MRI and subsequent invasive therapies including epidural steroid injections (ESI), facet injections, vertebroplasty and kyphoplasty.
- Overreliance on pharmacotherapy including opioids, muscle relaxants, tricyclic antidepressants and benzodiazepines.
- Overreliance on surgery, particularly lumbar fusion.
So what would a progressive model of spine care look like? We began building a new model in 1999 that has evolved over the past decades. It started with a philosophical underpinning grounded in evidence-based medicine.
First and foremost, it involved actively engaging patients in various rehabilitative modalities to move them away from the passive dependent model of care toward a model of active participation. The goals are to improve core strength and flexibility and reduce pain.
These programs begin with supervised physical therapy and then transition to maintenance therapy with a variety of modalities to choose from, including yoga, Pilates and strength training.
Other modalities with an evidence base to support their use include chiropractic care, mindfulness meditation, guided imagery and acupuncture.