Why stop using ROM as an Outcome Measure? It was replaced by DynaROM.

Written by John Maltby, DC and David Marcarian, MA

In a recent webinar and blog post, a well-respected individual in injury evaluation, highly recommended replacing Range of Motion Assessment as an outcomes measure with subjective-objective evaluations (e.g. Oswestry).   Apparently, he has not seen the latest edition of the AMA’s book “The Practical Guide to Range of Motion Assessment,” where the DynaROM is presented as the new gold standard. This device is not only one of the most important technological breakthroughs in 30 years but significantly improves the validity of range of motion measures. To suggest in this evidence-based world that we opt for subjective report over objective data, as this author did, is a poor decision considering the increasing demand by insurers, courts and the public for healthcare providers to support their clinical decisions with objective data. John Gerhardt, MD, the inventor of modern range of motion technology, determined that range of motion, when augmented by simultaneous measurement of muscle guarding, significantly increased the sensitivity and specificity of range of motion measures. Clinically, he found 70% of his patients with muscle guarding and pain demonstrated normal range of motion values. The DynaROM quickly and easily presents muscle guarding in an objective, quantitative manner and the process is familiar as it’s simply performing range of motion measures with ECG electrodes attached to measure the muscle guarding component. 

​DynaROM has been established through US Patent # 9,808,172 B2 specifically for its ability to evaluate for soft tissue injury. Geisser, from University of Michigan, corroborated the findings of Gerhardt. In his meta-analysis, he found combining muscle guarding and range of motion measures leads to a significant increase in sensitivity and specificity of range of motion measures when evaluating for low back pain. 
In the medical-legal arena (Merritt vs. Florida DOH), the validity of the DynaROM for evaluating soft tissue injury was challenged to the State Supreme Court level, defended by 300 insurance companies, the State of Florida, 9 expert witnesses and 75 attorneys.  Only one expert and one attorney represented the chiropractic profession and its use of the DynaROM technology.  Even with the millions spent by the insurance companies, DynaROM was established as valid in the lower court, Superior and Supreme Court levels and lead to a statute in the State of Florida acknowledging the DynaROM as an “Approved Diagnostic Device,” requiring reimbursement from insurers in personal injury cases. (Both the case files and superior court video can be reviewed at www.dynarom.com.) This landmark case supported the CPT code (96002, 96004) and led to inclusion in the AMA’s Medical Text.
80 years ago, BJ Palmer pioneered the chiropractic use of medical technology to create a scenario where DCs provide objective data that would not be questioned by medical doctors. Would you trust a cardiologist who believed a stethoscope is adequate for evaluating heart conditions; that the EKG is unnecessary? Chiropractors practicing PI without the DynaROM is like a cardiologist practicing without the EKG.

​We lose all credibility and control without the use of objective data to establish need for care and when a patient is at MMI. This patented, court-proven technology raises the level of professionalism and credibility of the practicing DC because the DynaROM data not only prevents IMEs or adjusters from cutting off care but gives you the control to make accurate clinical decisions without interference from IMEs and insurance companies.  With the current Gallup Poll numbers, we need tools that bolster the publics’ view of chiropractic. 
Instead of spending $150 taking PI attorneys out to lunch with no ROI, invest in this innovative technology and watch your practice take off.  Attorney Mike Maxwell called it “The Holy Grail for soft tissue cases,” and strongly urges doctors to implement DynaROM because it allows him to establish a solid case up front.  Attorneys don’t generally  

send clients to chiropractors but will seek out those who use DynaROM leading to an implied referral.   
We live in an evidence-based world, and data is paramount in any successful practice. The suggestion of replacing ROM assessment with subjective report over objective data is simply outrageous, especially with technology like DynaROM so accessible. I think we need to do what BJ suggested in 1938: “provide proofs that are the last word and incontrovertible.” If BJ were alive today, I don’t have any doubt he would fully integrate the DynaROM on each and every patient.  ​

References
1. Nederhand MJ, IJzerman MJ, Hermens HJ, Baten CT, Zilvold G. Cervical muscle dysfunction in the chronic whiplash associated disorder grade II (WAD-II). Spine 2000 Aug 1;25(15):1938-43.
2. Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Arch Phys Med Rehabil 1991;72:1080-7.
3 .Sihvonen T, Huttunen M, Makkonen M, Airaksinen O. Functional changes in back muscle activity correlate with pain intensity and prediction of low back pain during pregnancy. Arch Phys Med Rehabil 1998;79:1210-2.
4. Geisser, ME, Ranavaya, M, Haig, AJ, Roth, RS, Zucker, R., Ambroz, C, Caruso, M. A meta-analytic review of surface EMG among persons with low back pain and normal, healthy controls. The Journal of Pain, Vol 6, No 11 (November) 2005: pp 711-726.
5 .Gerhardt, JJ, Cocchiarella , L & Lea, R.A. The Practical Guide to Range of Motion Assessment, 2009. Published by the American Medical Association.
6 .Merritt vs. Florida DOH.  Case # 04-1149RX Download case files at https://www.dynarom.com/supreme-court-case.html