Bed rest and neck braces. I am still amazed that there are some back-pain sufferers who attempt these out-dated treatments for uncomplicated spinal pain. I am even more surprised to find out that their doctor has recommended these interventions that were deemed inappropriate more than two decades ago.
Sometimes, even when the knowledge is there, actions are not taken, and old habits stay at the forefront. This is referred to as the “know-do gap.” In health care, the know-do gap exists in full force.
Studies tell us that it takes 17 years, on average, for 14 per cent of research to translate into practice. Seventeen years!!!
In my corner of the health care world, where spinal pain is the predominant complaint of most chiropractic patients, the idea of manual therapy and exercise as treatment tends to be the final choice for patients after medications have failed. The know-do gap is wide, and continues to grow, as patients often leave their doctors’ offices with a prescription rather than a referral for manual therapy or a list of exercise recommendations.
Clinical practice guidelines are recommendations that optimize patient care. They are (or they should be) based on the most recent and available evidence. Unfortunately, as the know-do gap is showing, implementing what we know into practice is slow, and sometimes never gets done at all.
Did you know that more and more research is telling us that it may be wrong to put ice on new muscle strains and joint sprains, and that the application of heat may be more beneficial? For decades, if not longer, every single health care worker learned about RICE for acute injuries — Rest, Ice, Compression and Elevation — RICE. Research is beginning to tell us that this may not be the best intervention. Changing this habit may take generations, if it even happens at all.
Change in clinical practice may take years to implement when the change may dramatically affect current health care stakeholders. Back pain is the second most common reason for a visit to the doctor, yet research tells us manual therapy and exercise is the best medicine. Nurse practitioners are proving to be of increasing value in delivering primary care. Even pharmacists are taking over some duties traditionally dedicated to primary care physicians.
Health care policy change cannot not occur quickly when manpower is not there for the demand. It would take years, if not decades, to train enough nurse practitioners and pharmacists for effective primary care management. If all back-pain sufferers immediately adopted research recommendations, wait times would dramatically increase for chiropractors, massage therapists, physiotherapists and acupuncturists. The manpower, and government funds, are just not there at the moment.
Effective health care depends greatly on implementing what we know to be right, even when there is conflict with tradition and philosophical ideas.
Now, if I can just close the know-do gap with my relationship with potato chips.
