What is DBC Active Spine Care®?
DBC Active Spine Care® is the internationally recognized, award-winning spine treatment program getting unprecedented results for spine patients around the world. DBC-based research has recently been published in the top spine specialty medical journals for its proven results through the toughest scientific criteria (randomized controlled trials) and most recently received the prestigious Volvo® Award for Scientific Research. DBC Active Spine Care is a breakthrough for spine care.
How was DBC developed?
The basic research for the DBC Active Spine Care program was started in multi-site international research centers during the early 1980’s. The current treatment method is the culmination of over 20 years of scientific research, multi-site clinical trials and over ten thousand successful patients.
Is DBC scientifically proven?
At DBC, we pride ourselves on conforming to the medical principles of Evidence Based Medicine thus the name DBC (Documentation Based Care). Evidence Based Medicine assures each DBC patient that any treatment they receive has been scientifically proven as well as clinically reliable to work for them. This is in stark contrast with many rehabilitation centers that may formulate their own program along with claims that contradict the scientific literature and consensus. Though DBC is a leader in spine technology, DBC works in cooperation with leaders around the world and embraces the reality that DBC will continue to evolve and improve over time. DBC’s dedication to Evidence Based Medicine principles assures each DBC patient they will receive and continue to have the full benefit of scientific advancements in spine care.
How long is the DBC Program?
The DBC program varies in duration depending on the needs of the patient. Factors influencing the duration are the return of segmental neuromuscular control, mobility, muscular endurance and the adaptation rates of the segmental, and supporting tissues.
Each
patient’s duration of treatment in the DBC Active Spine Care program
is based on the time-course-of-adaptation required to reverse the extent
and category of degeneration that has occurred. The extent of degeneration
is measured by DBC’s proprietary evaluation technology including
the highly accurate (r=.90) and proprietary Spectral Analysis Electromyogram
(SAEMG).
First time acute patients may not need DBC at all. Sub-acute patients with 4 to 12 weeks of continued pain may require 6 weeks of treatment, 2 times per week. This is possible because actual tissues have not had time to significantly degenerate. Although neuro-motor control is quickly lost after an injury, these components also adapt quickly to properly controlled stimulation.
Recurrent or persistent spine patients may require 2 treatment per week for 12-weeks. Post-surgical and other patients with varying degrees of degeneration will be prescribed individualized programs based upon researched outcome for each pathology. All patients are also given a free home program to maintain their results and may also participate in an ongoing maintenance program at the clinic.
Why is the DBC protocol only 2 times per week?
When the DBC protocol was developed, DBC conducted iterative, comparative studies evaluating the effectiveness of different frequencies of treatments and their effects on adaptation and safety. The DBC protocol is 2 times per week because clinical trials showed this frequency maximized tissue adaptation while minimizing risk of over-stimulation and increased pain. Unlike therapy for other joints that can be protected from use during the recovery phase of the adaptation process, the spine must continue its function between treatments, effectively reducing the recovery time between treatments. The DBC studies indicated that this frequency was optimal since it achieved the maximum adaptation rates as 3 times per week while the more frequent visits increased risk threefold and increased cost by 50% without additional benefit.
DBC provides care that is based on outcomes for the long-term benefit of our patient. The DBC program has received widespread support among the health care providers and insurers, as they become more informed and discriminating in the services they prescribe and reimburse. We should be careful to clarify that the results found with DBC should not be misrepresented to suggest that performing other, or less effective, programs twice per week over similar periods would be any more productive than they already are, or are not. On the contrary, it identifies the glaring deficiencies of programs developed without sufficient research.
Is this work hardening?
No. Work hardening uses the theory of "task-specific reconditioning" which is specific to the patients job task, but does not address the specific area of injury, nor the adaptation needed to return the patient to job specific tasks. Work hardening theory hopes, that by progressively increasing exposure of the whole body chain to simulated work situations, the body will somehow adapt to the increasing demands of performing simulated job tasks. This is usually done in a controlled environment where patients are taught to concentrate on proper ergonomics and invoke conscious compensation mechanisms to "adapt" to, or rehearse, simulated job-task Requirements.
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Unfortunately, work hardening does not address non-standard and non-rehearsed tasks, nor does it adequately prepare the patient for the common occurrences when proper ergonomics are not possible or are neglected. Studies show that job-related injuries increase when workers perform non-standard or non-rehearsed tasks. Additionally, spine problems that may be a normal occurence in life or injuries that occur off the job will likely have a recurrent episode on the job. These very situations that put workers at highest risk and employers/insurers at high liability, are the high risk, real-life situations that work hardening does not address. |
DBC is spine-specific adaptive therapy, which objectively documents specific deficiencies and develops an individual program to correct each deficiency before involving the whole body chain. DBC develops each component to be properly prepared for standard and more importantly non-standard tasks to decrease the risk of injury when proper ergonomics are not possible or neglected. DBC’s goal is to protect the patient from re-injury both on and off the job so the patient does not need additional care.
| The effectiveness of DBC’s approach is illustrated by DBC International’s extensive cumulative data base that shows an average of 14 days off work during the 12 months prior to entering the DBC, and an average of only 1 day of work missed during the 12 months after DBC. |
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Work hardening or work conditioning may be useful if limited to its proper application -- for use after DBC has returned the spine to a dynamically functioning level. However, it should not inappropriately be used to recondition the spine. DBC clinicians work with patients to address specific work related tasks during the DBC program. In situations where total body reconditioning may be necessary, appropriate programs are also used to recondition the other body areas during and after DBC.
Is this normal Therapy?
No. Traditional pain relieving therapies (heat packs, massage, modalities, etc.) are used to treat symptoms of acute injury (first-time or fresh injuries) or improve blood circulation after trauma. The DBC protocol is researched and proven to address the individual’s specific debilitation and resolve the deficiencies that can keep back/neck patients from getting better or cause recurrence. DBC’s Adaptive Response Therapy works to recover full function which allows DBC graduates to remain healthy through normal activity (similar to normal non-injured people in most cases) and reduce future risk of injury or reinjury. DBC incorporates unique, patented and FDA listed, testing and training devices specifically designed to initiate, sustain and control adaptation through careful doses of load and motion while isolating the target areas of the spine. Other programs that typically perform subjective evaluations or total torso tests may not identify the specific problems. DBC’s ability to isolate the spine in testing and cause specific adaptive responses in the spine during treatment is so unique it was awarded patents in the US as well as many other countries around the world.
Does this take the place of surgery?
No. When surgery is clearly indicated, research supports that spine surgery is the best course of treatment with proven good outcomes. The challenge is that most spine patients do not have clear surgical indications.
In the past, conservative rehabilitation was used in an attempt to screen out patients who did not need surgery. Unfortunately, the science and technology did not exist for spine rehabilitation to be effective, so they did the best they could. We now know that these rehabilitation programs lacked the scientific or medical evidence--the consensus of high-quality studies conclude that traditional rehabilition is no more effective than placebo for spine patients. Since traditional rehabilitation was not an effective way to separate appropriate surgical candidates from inappropriate ones, surgery had been limited to being the treatment of last resort--when the condition had gotten so unbearable the patient had little to lose. This process resulted in the traditional surgical outcomes where 50 percent got better, and 50 percent became worse after the surgery. Most people know friends who lost this coin toss and may have even opted for subsequent tries. Many unfairly blame surgeons or rehabilitation providers for these poor outcomes when in fact, the technology was just not available to do better, until now. DBC is now being used by leading physicians from family practice through pain management and surgeons as a evaluation tool to separate conservative (non-surgical) candidates from surgical ones and as the exclusive rehabilitation program to restore lost function once the surgeon has repaired the mechanical problem which may have initiated the debilitation or have been the result of debilitation that had not been addressed properly. With this new effective screening method, leading surgeons are now achieving unprecedented positive outcomes of 80 to 90 percent for their non-surgical and surgical patients. With DBC as the new screening method, solution-oriented physicians can now consider surgery as a more predictable and effective course of treatment, patients can now be more confident of both their conservative and surgical options, and payers can be assured of cost effective quality care without fear of going down the never-ending cycle of ineffective and expensive treatment. Consider which generation of health care technology will be available to you when selecting your health care professionals or network. DBC facilities have a list of physicians and insurance providers in each area known for their advanced outcomes (see the link to Locations or email us at email@DBCAmerica.com).
Will this help Degenerative Disc Disease?
Many symptoms of functional debilitation mimic that of Degenerative Disc Disease. The challenge is determining the difference. Physicians find DBC very useful to help separate patients who only have debilitation from being categorized into the vague and perceptively more serious category of "Degenerative Disc Disease". Leading physicians who use DBC find that over 85 percent of those who have previously been, or about to be, labeled with Degenerative Disc Disease are helped through DBC, or merely had back pain symptoms also associated with Degenterative Disc Disease. Even most with actual Degenerative Disc Disease improve function, reduce pain and reduce its effects. DBC objectively quantifies spinal function and adaptation rates to identify positive response which would indicate debilitation versus irreversible disease. This is not to say that failure in other programs not proven to be effective, should be used as an indicator of the severity of a specific patient. On the contrary, the predictible lack of outcomes of providers are too often blamed on the severity of the disease or willingness of the patient.
Medically published Randomized Controlled Trials with two-year follow-ups on spine patients using DBC versus traditional therapy (control) clearly show that DBC helps return even long-term patients to normal while traditional therapy had no immediate or long-term benefit (confirming the current consensus of high quality research).
Why is the DBC protocol unique?
The DBC protocol is based on scientific research and developed to produce reliable patient outcomes. The dosage of therapy applied in each session, the distinct phases and the designed progression within each phase of the DBC protocol are based on physiological and neurological adaptation rates. Consequently, the copyrighted content of each session, the frequency (2x per week) and the length of the protocol has been developed only after extensive scientific research on adaptation and iterative trials with safety and patient results as the measurement of success.
DBC determines a patient’s individual program based on what has proven to work for patients of similar situation and characteristics. Each of the DBC clinics (over 70 and growing) updates the database of over 10,000 patients and over 6000 normal subjects. DBC continually analyzes this database to identify patterns and continually improve the DBC protocol and its outcome.
For example: Recent research by DBC has shown that complications during reconditioning occur most when the rate of adaptation in the strength component increases greater than one standard deviation above DBC’s prescribed progression rates. This is due to the fact that the strength component is capable of increasing faster than the supporting tissues can tolerate. DBC monitors each patient’s progress to remain out of the high-risk zone.
DBC is advanced science applied by specialized clinicians. Each DBC Certified Clinician must be certified through an intensive course in spinal function, pathology and adaptive response therapy.
DBC is the international standard - the clinically tested, medically proven and published, scientific program for the specific evaluation and functional restoration of back and neck problems.
Does DBC work like "good old" therapy?
Traditional acute therapy may help the acute symptoms of an injury during the first 4 weeks. Fortunately, 90% of people with back problems will resolve by themselves, with or without intervention within the first four to six weeks. The medical literature indicates that intervention during this period, regardless of type of therapy, does not seem to improve this outcome. Beyond this, the limited research and technology of "good old" therapy seems to be unable to adequately isolate, mobilize and work the spine to get results when put to the test in high-quality medical research (Randomized Controlled Trials vs. lower quality claims based on "studies" that have not passes peer review, use case studies, have poor design or bias, based on anecdotes, can take credit for external factors, etc.). DBC is the medically-proven program for spine problems. At the same time, DBC is self-disciplined and careful not to over-utilize treatment where it cannot be proven to provide specific benefit, or accept credit for healing those who would recover without intervention (VOLVO® Award for Scientific Excellence).
"Why should patients be blamed for the lack of outcomes of the provider?" "Why should the insurance company be blamed for not wanting to pay for more care that has not worked for the insureds and confirmed as ineffective in the medical literature?" "Why should the physician be blamed for trusting that conservative options haven't worked?" These are all good questions that can be resolved by Evidence Based Medicine (EBM) and Documentation Based Care (DBC) standards that insure that claims are accurate, supportable and justified.
If "good old" therapy didn't work for you, you have had back problems for more than 4 weeks, you have had to limit your activities to accommodate your condition, you have had 3 or more back episodes in your lifetime, or you have had back related problems twice in one year, you may have a serious condition that will likely not go away by itself or with a placebo-level program. Fortunately, you may be a good candidate for success (over 87% success with over 10,000 patients) through the DBC Active Spine Care program.
What is included in the DBC testing?
Testing is DBC’s means of evaluating and quantifying the function of the spine. It documents pain levels and patterns, psychosocial variables related to pain such as depression, and musculoskeletal patterns of posture and balance resulting from the pain/injury, segmental instability and paraspinal endurance. The initial testing sets the baseline for documenting improvement and the initial levels of the protocol. The mid-term test reveals the function after segmental neuromuscular deficiencies have been corrected. With this information, the sustained dosage of activity needed to accomplish program targets can be determined.
The
new SAEMG (spectral analysis EMG) has been scientifically proven in published
research to be a valid means of detecting patients from controls and in
documenting patient progress through the DBC treatment program. Invasive
wire EMG tests have validated its effectiveness to a level of .95. This
device used in conjunction with the DBC published T-0 paraspinal fatigability
test has high correlation, .94, to the widely accepted Borg Test as an
indicator of paraspinal fatigue. Published research shows that spine fatigability
is a major risk factor in recurrence of spine problems.
What is the DBC home program?
The DBC home program is a natural continuation of the DBC protocol designed to maintain the clinical benefits provided by the DBC clinical program with the addition of more complex activities designed to reduce risk of future injuries. DBC’s clinical program also includes a daily home program that makes the transition to a home program and healthy lifestyle change very natural.
How much does the DBC program cost?
DBC uses standard CPT procedures and codes for billing and reimbursement. Therefore, DBC patients pay the same price for the DBC spine-specific, researched and published technology as other facilities would charge for a program that may not be proven, results that are not reliable or for the use of general fitness equipment available in health clubs.
What are the contraindications?
DBC has clear, scientifically evidenced contra-indications. Please contact your local DBC facility or referring DBC physician for more details.
Who oversees the program?
DBC International requires all DBC’s to have a MD or DO, as it’s Medical Director, and/or a PT or OT as Clinic Director. This is necessary for the proper application of the DBC protocols and to address the subtle musculoskeletal and compensatory patterns that are not readily apparent to those without proper training. DBC also Requires all clinicians treating DBC patients to be DBC Certified Clinicians by successfully completing the DBC sub-specialty certification course in spinal anatomy, biomechanics, pathology, rehabilitation and the DBC protocol.
How does a patient get into the DBC?
The DBC Active Spine Care® treatment program is only available through a prescription from a physician. Certified DBC Clinicians in each DBC clinic are available to work with treating physicians to discuss indications, contraindications, expected outcomes as well as develop treatment strategies, plans and targets.