In a recently published Scandinavian study the researchers conclude that Maintenance Care is more efficient than symptom guided care in reducing the total number of days patients must tolerate bothersome LBP over 52 weeks. In return Maintenance Care increases the number of treatments. The researchers recommend that clinicians consider Maintenance Care as a possible preventive care for recurrent or persistent LBP in patients in need of such care who have responded favourably to their first treatment.
Maintenance Care (MC) is often used to treat chronic or recurrent back pain. In the current study, researchers looked at how efficient MC is for treatment or reduction of episodes of persistent or recurring back pain compared to symptom guided treatment.
The main difference between the two treatment forms is that MC is clinician controlled, i.e. the chiropractor lets the patient know when he or she is due for the next treatment, whereas symptom guided treatment is controlled by the patient, i.e. the patient makes an appointment with the chiropractor when he or she experiences back pain.
The study was carried out as an RCT among a group of 328 patients aged 18 – 65, specifically chosen for this study. All had experienced a minimum of 30 days with LBP during the past year, had experienced several earlier episodes of LBP and had improved markedly by the time of the 4th treatment for the episode in question.
The participants were divided into two groups who were treated with either MC or symptom guided treatment for 12 months. After 12 months, the results showed that the MC group had an average of 13 days less with bothersome LBP during the trial period than the group who received symptom guided treatment. In return, the effect of MC was achieved with 2 more visits to the chiropractor than the group who received symptom guided treatment.
The researchers behind the study are Andreas Eklund (Karolinska Institutet, Stockholm, Sweden), Irene Jensen (Karolinska Institutet, Stockholm, Sweden), Malin Lohela-Karlsson (Karolinska Institutet, Stockholm, Sweden), Jan Hagberg (Karolinska Institutet, Stockholm, Sweden), Charlotte Leboeuf-Yde (University of Southern Denmark, Odense, Denmark), Alice Kongsted (NIKKB, Odense, Denmark & University of Southern Denmark, Odense, Denmark), Lennart Bodin (Karolinska Institutet) og Iben Axén (Karolinska Institutet, Stockholm, Sweden & University of Southern Denmark, Odense, Denmark)
The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain - A pragmatic randomized controlled trial. Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, et al. PLoS ONE 13(9) 2018 https://doi.org/10.1371/journal.pone.0203029