Question / Intervention Goal / Objectives
The Bockmann Technique strives to improve patients’ mobility and stability by focusing on streamlining the diagnosis and teaching self-treatment techniques. The improvement is reflected in the change in the Patient Specific Functional Scale (PSFS), which is administered at baseline and at treatment discharge. The Bockmann Technique achieves significant improvement in functional scores in fewer visits than benchmarks.
The PSFS score was taken at the initial office visit and at treatment discharge. The discharge score was taken at either the final office visit or by phone, if no office visit was needed. Each patient’s net improvement on the PSFS was calculated and compared to the minimum detectable change. The minimum detectable change is 3 points if the patient is working on only one activity; 2 points if more than one activity. An average of all patients’ score change was calculated.
The number of visits between start and discharge was also noted for each patient. The average number of visits was calculated, as well as the mode for all patients who had at least one visit, regardless of whether a follow-up PSFS score was available.
The Patient Visit Average (PVA) was calculated by taking the ratio of the visits each month by regular, ongoing patients to visits by new patients. This measure was done at the level of the chiropractic practice, and then compared to a national benchmark.
Findings / Metric/ Outcome/ Savings
The average PSFS score improvement was 4.51 points for the 82 patients who had follow-up scores; this average includes 4 patients who had less than the minimum detectable change in score. (See chart below.) The average number of visits was 2.5 among all 160 patients; the most frequent (mode) number of visits was 2. This compares favorably to benchmarks from literature, such as Nicholas et al 2012, which had an average of 5.8 visits to achieve a 5.1 PSFS score improvement. Other studies assess the PSFS at the sixth or eighth treatment visit or refer to the amount of time between first and final visits.
Of the 82 patients with follow-up scores, approximately 70 percent achieved a 75% or more improvement in PSFS scores over the course of treatment. Another 14% had between a 50 and 75% improvement.
The practice’s PVA was 2.0 for 10 months; thus, on average nearly half of the patients served each month were new. The national benchmark PVA was 51.3, which would reflect close to two percent of patients being new each month. A lower PVA points to shorter treatment times, fewer office visits, and thereby, lower costs.
As with all observational studies, the measure is limited to patients who provided a follow-up PSFS score. In Nicholas et al, 54.8 percent of patients completed the PSFS at discharge; this is somewhat higher than the completion rate in this sample, which was 48.75 percent including all patients, and 51.6 percent excluding patients who were referred elsewhere.
 Chiropractic Economics, 22nd Annual Salary & Expense Survey, Issue 8, May 2019
 Nicholas et al, The use of the Patient-Specific Functional Scale to measure rehabilitative progress in a physiotherapy setting J Man Manip Ther. 2012 Aug;20(3):147-52. doi: 10.1179/2042618612Y.0000000006
 Horn et al, The Patient- Specific Functional Scale: Psychometrics, Clinimetric, and Application as a Clinical Outcome Measure, Appendix D, Journal of Orthopaedic & Sports Physical Therapy 2012 January 42 (1)