Newsletter

What is IMC?

 Integrated Mechanical Care (IMC) is a management process for spinal and peripheral joint pain and injury. Its foundation is Mechanical Diagnosis and Therapy (MDT) and is based on 35+ years of combined clinical experience and ongoing scientific review.

Who are we?

Chad Gray PT, Cert. MDT graduated from Florida A&M School of Physical Therapy in 1994, and has practiced Physical Therapy in Tallahassee since that time, in an outpatient setting.  He is currently co-owner of The Center for Orthopedic and Sports Physical Therapy.  He is credentialed in Mechanical Diagnosis and Therapy through the McKenzie Institute.  For the past four years, Chad has helped provide the education for spine pain management to the Family Practice Residency Program at TMH.  He co-founded OIMI with Mark Miller in 2003, an injury prevention company dedicated to reducing occupational injury in the workplace.  In 2006 he helped design and implement the CHP Back Pain pilot program to help reduce cost trends associated with management of spinal pain in the North Florida region.

 

 Mark Miller PT, Dip.MDT graduated from the University of Toronto in 1987, and has practiced physical therapy since this time.   He has owned private PT clinics in Ontario, Texas and Florida.  and is faculty with the Mckenzie Institutes U.S.A. and International.  Mark has taught over 250 continuing education courses and has spoken at numerous American and world-wide conferences dedicated to the assessment and treatment of spinal and peripheral joint pathology.  As well, Mark worked for a number of years as a consultant to Texas Mutual Insurance Company, regarding Worker's Compensation treatment and reimbursement issues, along with being one of 3 diploma tutors for the McKenzie Institute International's residency program.

The Bottom Line 

They key component to the proper management of musculoskeletal injury and pain is an assessment or evaluation that has proven inter-tester reliability.  Inter-tester reliability speaks to the ability of a group of clinicians at different times or in different locations examining the same patient to come to the same conclusions about that patient's condition.  The only assessment in medicine that has been proven reliable in randomized controlled trials is the MDT assessment.   In fact the only assessment recommended by the Occupational Disability Guidelines (ODG) adopted by the states of Texas and California, is the MDT assessment.  This assessment has 7 randomized trials that demonstrate its inter and intra-tester reliability.

Why is the reliable assessment process so important?  If there is no agreement on the musculoskeletal assessment then the appropriate care or treatment cannot be applied to the problem identified.     Patients that have a mechanical problem need to be directed to the clinicians that provide mechanical treatment (Physical Therapists, Chiropractors), patients with an inflammatory or chemically dominant problem need to have a chemical treatment applied to their condition (pain management procedures such as facet injections, epidurals, rhizotomies or prescription medication) , patients with problems that require a surgical intervention and have failed conservative care need to be moved on to the appropriate provider of surgical care.  In addition to these patient types there are also the populations of patients that have a problem that is dominant from a psychosocial perspective and does not need to be treated within the medical model. These patients should be quicklyidentified and moved on to the proper mental health intervention or introduced to a functional restoration program and returned to normal activity.  The ability to properly select these patients for the correct care from these providers is dependent upon the assessment and its ability to accurately place these patients in these groups.  Without this selection   process the patient cannot be expected to end up with the appropriate provider and the outcome will be less than desirable.  

This process is in direct conflict to the medical model currently in place. In the system as we know it the treatment is applied to the problem based upon the training of the clinician providing it.  This allows for a random and arbitrary assignment of interventions across a population of clinicians all treating the same medical condition.  It is this method that has produced the poor outcomes and lack of patient satisfaction with care and is the primary reason that a reliable assessment must be used to deliver effective treatment for musculoskeletal injury and pain.  Until this problem is addressed the ineffective care will continue to be applied and the result will be no different than what we have realized. 

 It is this MDT assessment that is the foundation of the IMC program and is the primary reason that the outcomes associated with IMC have been so superior to any other outcomes produced in medical management of musculoskeletal injury and pain.    Every clinician operating under the IMC umbrella is trained by the McKenzie Institute and has the appropriate level of training necessary to produce these outcomes.  The scientific studies examining effectiveness of the MDT process have recognized that it is contingent upon training to produce the outcomes.    IMC also monitors each licensed clinic to ensure that the outcomes produced in Tallahassee will be produced in each of these sites.

From the Field – Expert Testimonial

Mechanical Diagnosis and Therapy (MDT), also known as "McKenzie care", is a clinical method for evaluating and managing painful spine problems that is ideal for identifying the mechanical cause of, and the solution to, the majority of low back and neck pain.  There is more published research validating this clinical approach than any other means of treating these disorders.

Every group health and workers' comp payer, and every self-insured employer, would do themselves a great favor by seeking and accessing quality MDT care, as early as possible, for their members and employees struggling with low back or neck pain.

Integrated Mechanical Care (IMC) is a unique network of physical therapy and chiropractic clinics that specialize in providing excellent MDT care.  By closely monitoring the outcomes of each member clinic, IMC guarantees its contracted payers and employers the highest quality of care which translates into extremely high rates of savings by avoiding the need for most medications, imaging, injections, and surgeries while also achieving very high patient satisfaction and greatly reducing recurrences.

Ron Donelson, MD, MS