Klinikka (Pty) Ltd, the DBC Sub License Holder in South Africa, have shared with us this presentation. Another insightful way to explain the value proposition of the DBC Back Treatment Program. #physiogym #backpain #DBCBusiness

2. AGENDA
Startling back surgery statistics
What can be done? Local patient case studies
How does DBC achieve these dramatic recoveries?
Who is DBC and what exactly do they do?
Where is DBC?
Benefits for medical schemes

3. Startling back surgery statistics
• “Study reveals that back surgery fails 74% of the time”
• “After two years, only 26% of those who had surgery
had actually returned to work. That’s compared to
67% of patients who didn’t have surgery, even though
they had exactly the same diagnosis”
Source: Spine – the medical journal considered the leading orthopaedic journal
covering cutting-edge spine research

4. Startling back surgery statistics
• 41% increase in the use of painkillers, particularly
opiates, in those who had back surgery
• 30-40% experience post-operative complications
• Psychological devastation due to Failed Back Surgery
Syndrome
Source: Medical Journals including Spine, considered the leading orthopaedic
journal covering cutting-edge spine research

5. Failed Back Surgery Syndrome
“By far the number one reason back surgeries
are not effective and some patients experience
continued pain after surgery is because the
lesion that was operated on is not in fact the
cause of the patient’s pain.”

6. Failed Back Surgery Syndrome
The deterioration of
the patient’s
physical condition,
psychosocial load
and sensitisation to
pain are often
interrelated

7. What can be done?
Two local patient case studies
Demonstrating the turnarounds achieved by DBC’s
•active rehabilitation,
•functional restoration and
•cognitive-behavioural approach

8. Patient case study 1
Patient history
•61 year old female with history of neck and back pain
•Neck
• Progressive weakening of the left arm
• Pain in C7 level radiating down to mid-thoracic level and left arm
•Back
• Complained about severe low back pain that radiates to glutes bi-
laterally and down left leg
• Increased pain at night leading to sleep disturbances

9. Patient case study 1 – MRI results
• C2/3
Facet joint degeneration with no
discogenic pathology
• C3/4 and C4/C5
Early reduction in discus signal with facet
joint irregularity
• C5/6
Discus degeneration with central disc
bulging degeneration of facet joint L
more prominent
• C6/C7
Discus degeneration with central disc
bulging degeneration of facet joints
• C7/T1
Discus degeneration with central bulging
facet joint degeneration

10. Patient case study 1 – MRI results
• L2/L3
Discus degeneration with bulging and
anterior osteophyte formation
• L3/L4
Early reduction in discus signal with facet
joint degeneration and flavim
hypertrophy
• L4/L5
Discus degeneration with disc bulging
degeneration of facet joint L more
prominent
• L5/S1
Discus degeneration with discus herniation
central and towards the left with
pressure on dural sac

11. Patient case study 1
The MRI “indicated” neck and back surgery (±R300 000)
The patient decided to try the DBC programme first
And a good thing she did…

12. Patient case study 1
BEFORE DBC
•Neck pain 70/100
•Back pain 90/100
•Limited lateral and rotational mobility
•Increased multifidus (back muscle) activity
in L side
•Abnormal contraction-relaxation reflexes
AFTER DBC
•Neck pain 0/100
•Back pain 30/100 (normal range)
•Normal ranges of motion
•Normal multifidus (back muscle) activity
•Improved contraction-relaxation reflexes
Range of
Motion
Flex Extend Rotation
L
Rotation
R
Neck 5° 10° 35° 35°
Back 30° 15° 40° 35°
Range of
Motion
Flex Extend Rotation
L
Rotation
R
Neck 45° 25° 45° 45°
Back 45° 20° 65° 50°

13. Patient case study 1

14. Patient case study 2
Patient history
•17 year old male involved in a motorcycle accident
•Patient complained about muscle spasms in lower back and pain
down his left leg

15. Patient case study 2 – MRI Results
• L3/L4
Discus bulging
• L4/L5
Discus bulging
• L5/S1
o Discus degeneration with
central prolapse with pressure
on dural sac
o Slight inferior discus bulging
with in the foramina
Discus degeneration with central
prolapse with L5/S1 pressure on
dural sac
Slight inferior discus bulging with in
the foramina

16. Patient case study 2
The MRI “indicated” back surgery (R140 000)
The patient went for a second opinion and was referred
to DBC
And a good thing he was…

17. Patient case study 2
BEFORE DBC
•Back pain 80/100
•Limited flexion, lateral and rotational
mobility
•Abnormal contraction-relaxation reflexes
•Increased muscle activity and increased
fatigue rate
AFTER DBC
•Back pain 0/100
•Daily living activities – Pain free!
•Normal ranges of motion
•Improved contraction-relaxation reflexes
•Improved muscle activity and improved
fatigue rate (within normal limits)
Flex Ext Rotation
L
Rotation
R
Lateral
flexion
L
Latera
l
flexion
R
25° 30° 28° 20° 43° 37°
Flex Ext Rotation
L
Rotation
R
Lateral
flexion
L
Latera
l
flexion
R
50° 30° 65° 68° 60° 60°

18. Patient case study 2

19. How?
How does DBC achieve these dramatic recoveries?
Exceeding international best practice
Independent interdisciplinary treatment teams

20. International clinical best practice
COCHRANE REVIEW
COCHRANE REVIEW (WHAT IT IS)
•The world leader in Evidence-Based health care
•The summary and interpretation of the results of recent and up-to-date medical
research
COCHRANE REVIEW OF EVIDENCE-BASED PHYSIOTHERAPY
•Current Research does not provide Evidence-Based support for the majority of
traditional physiotherapy treatments
WHAT DOES CURRENT RESEARCH SUPPORT FOR MUSCULOSKELETAL
PHYSIOTHERAPY?
•Progressive Exercise
•Treatment implementation in association with a Cognitive Behavioral Approach
•Mobilisations

21. DBC Treatment Strategy
WHAT DBC PROVIDES
•Individualised Progressive Exercise Therapy
•10 years experience in the application of a Cognitive Behavioral Approach to
Physiotherapy
•Area specific active mobilisation

22. Cochrane Best Practice vs. DBC
(for lower back pain)
HEREANIMATED GRAPHS
DBC
(>60 000 PATIENT CASES)
23,3
DBC
(>60 000 PATIENT CASES)13,6
DBC
(>60 000 PATIENT CASES)
MOST EFFECTIVE
INTERVENTION
CHARACTERISTICS
(HAYDEN ET AL.)
18,1
MOST EFFECTIVE
INTERVENTION
CHARACTERISTICS
(HAYDEN ET AL.)
MOST EFFECTIVE
INTERVENTION
CHARACTERISTICS
(HAYDEN ET AL.)
5,5
PAIN REDUCTION FUNCTIONAL GAIN

23. Who is DBC?
Documentation Based Care (DBC) is the global leader in
musculoskeletal rehabilitation.
For over 20 years we have pioneered a growing global
network of advanced specialist centres with a definite
goal: to provide better results, more efficiently, with
greater cost benefit.
“We deliver active rehabilitation”.

24. Who is DBC?
We have developed the industries best protocols to
successfully and effectively promote functional ability
and work capability to the chosen target group.
The company’s mission is to deliver these services, for
the benefit of the working community and individual
patient, while continuously developing the protocols in
order to advance functional ability and work
capability of the individual.
“We deliver active rehabilitation”.

25. Who is DBC?
We have built a central database containing baseline
and outcome data from over 100 000 treated
patients.
This data, together with new findings from on-going
research, is used to continuously improve the efficacy of
treatments.
Collective experience coming from clinic installations
implemented in more than 20 countries

26. So what exactly does DBC do?
NECK
BACK
RESTORING RANGE OF MOTION
RESTORING MUSCLE CO-ORDINATION AND MOVEMENT CONTROL
IMPROVING MUSCLE ENDURANCE AND STRENGTH
IMPROVING GENARAL CONDITION
RE-EDUCATION BETWEEN NORMAL LOADING AND PAIN
REDUCING FEARS AND AVOIDANCE BEHAVIOUR
TACKLING PSYCHOSOCIAL OBSTACLES
ENCOURAGING CONTINUED ACTIVITY

27. DBC Treatment Process
INITIAL ASSESSMENT TREATMENT PLANNING TREATMENT (1:1-3)
• Initial Online
Questionnaire
• Clinical Assessment
• DG/Pain Pattern
• Functional Impact Sub-
classification
• Choice of Treatment
Direction
• Treatment Content;
Plan and Patient
Contract
• Instruction
• Device Training
• Functional Training
• Symptom Treatment
• Progress check
OUTCOME ASSESSMENT
• Outcome Questionnaire
• Clinical Assessment
• Treatment Outcome
Assessment
• Maintenance Program
FOLLOW UP
• Assessment
• Instruction
• Health Coaching

28. DBC Treatment Process
1. Patient
•At the beginning of treatment and at the end of each treatment module there is a one-on-
one assessment session with a trained GP of 90 minutes.
•Treatment sessions for DBC functional rehabilitation are for 60 minutes, twice a week
•The length of the treatment program is dependent on the severity of deconditioning.
2. Baseline assessment
•Online questionnaires include a clinical and functional evaluation
•A bio-psychosocial profile of the patient is then produced and used in the design of an
individual treatment plan and in assessing prognostic factors for a good recovery.
[1:1 60-90 minutes]
3. Treatment
•The individualized treatment plan combines highly specific exercises using the DBC
treatment devices together with systematic cognitive-behavioural support.
•The treatment process utilizes 1 clinician: 1 client treatment sessions and small group
training of 1 clinician: 2-3 clients, to exploit the positive influence that group behaviour is
known to have on treatment results.
[1:1-3 60 minutes] →if necessary →
[1:1 30-60 minutes, symptom treatment & guidance]

29. DBC Treatment Process
4. Outcome monitoring
•The outcome evaluation provides information on the progress and treatment outcomes
against the initial parameter levels of the baseline assessment.
•Progress checks also enable timely adjustments of the treatment plan when necessary
and these checks may be repeated for longer-term follow up assessments.
[1:1 60 minutes]
5. Continued activity
• The results obtained with the DBC functional rehabilitation process have proven to be
maintained through continued activity.
• The continuing benefits are evident both in terms of living free of chronic pain and trouble
as well as avoiding absenteeism from the work place.
• This continued activity can be the clients own activities or can be continued with group
training that the clinics may organize.
[1:5-10 60 minutes]

30. DBC Outcomes (Back)
Pain Functional impairment
Most common

31. DBC Outcomes (Neck)
Pain Functional impairment

32. Where is DBC?
International footprint Started in Finland, now in
22 countries on 4 continents
Europe
Belgium
Finland
Ireland
Italy
Luxembourg
Netherlands
Poland
United Kingdom
Middle East
Arab Emirates
Africa
South Africa
North America
United States
Asia Pacific
Hong Kong
Malaysia
Singapore
Thailand

33. Where is DBC?
Local footprint 8 Independent interdisciplinary
group practices in South Africa
and rapidly expanding
Gauteng
Centurion
Pretoria East
Illovo
Mpumalanga
Secunda
Emalahleni
(former Witbank)
Western Cape
Cape Town
KwaZulu Natal
Durban
Free State
Sasolburg

34. Benefits for medical schemes
Case study of a mid sized employer based scheme

35. Medical scheme case study
Back/neck-related admissions total cost per life per month (2006-2014)
DB C was
introduced in this
scheme in 2010.
29%*
saving!
*R13.6m saving in 2014

36. Medical scheme case study
Back/neck-related admission rate (2006-2014) DB C was
introduced in this
scheme in 2010.
24%
115 admissions
saved in 2014!
Reduced absenteeism
and presenteeism

37. Medical scheme case study
Initial clinical assessment and outcomes (2014)
Outcomes
rated
“good”

38. Medical scheme case study
Reducing pain intensity to normal
and below normal (2014)
Reduced absenteeism
and presenteeism

39. Benefits for medical schemes
Benefits for members
Live again!
Get your body back
 Hugely reduced pain
intensity
 Improved range of
motion for daily
activities
Benefits for corporate
clients
Reduced absenteeism
Reduced presenteeism
Musculoskeletal disorders often account
for more pain and sickness absence from
work than any other medical condition

40. Benefits for medical schemes
Clinical outcomes
Reduced pain intensity to normal levels
Improved Range of Motion
 Bending forwards and backwards
 Left and right rotation
 Back patients: lateral bending left and right
Improved muscle function
 Measured by ElectroMyoGram (EMG)
Virtually all patients reported a good outcome

41. Benefits for medical schemes
Cost savings
Avoid costly surgeries and readmissions
 Spinal fusions at R136 000 per admission
 Laminectomies at R113 000 per admission
 A significant number of patients are readmitted within two
years of the initial surgery
Savings in cost per life per month
 Back-related hospital admissions cost local medical schemes
in excess of R2bn during the past year
 Savings of 29% in the case study shows that estimated savings
of 25% (R500m for the industry) is therefore not unreasonable

42. Thank You