Technique Update: Patients Best Suited for Maintenance Care

Technique Update:  Patients Best Suited for Maintenance Care
By Dr. David Graber

The strongest study on the support for “maintenance-care” (MC) in the world of chiropractic was published this week by Andreas Eklund, Iben Axén, and their team.

In this Haldeman Award-winning study, Dr. Eklund and team tracked 319 patients with recurrent and persistent low back pain. They divided these into psychological sub-groups and could identify could identify which were responders and non-responders to MC.
Those individuals classified as dysfunctional were, “characterized by high pain severity, marked interference with everyday life, high affective distress, low perception of life control and low activity levels.”, were able to use regularly scheduled appointments (every 1-3 months) to:
– Stabilize their clinical course
– Increase the number of pain-free weeks between treatments.
The takeaway message is that for chronic or repeated back pain patients MC is not a cure that prevents new episodes but rather a management strategy that may reduce bothersome (activity-limiting) LBP over time for a carefully selected group of patients with a dysfunctional profile. Patients who adapt well to their pain, who experience only little interference, have an active lifestyle and do not experience high levels of distress are not suited for MC and should be cared for on an episode to episode or as-needed basis.

Eklund, A., Hagberg, J., Jensen, I. et al. The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain – a secondary analysis of a pragmatic randomized controlled trial. Chiropr Man Therap 28, 19 (2020).


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