Newly Published Study Confirms
That “Maintenance Care” Delivers!
SOURCE: Spine (Phila Pa 1976) 2011 (Aug 15); 36 (18): 1427-37
Senna, Mohammed K. MD; Machaly, Shereen A. MD
Shereen A. Machaly, MD,
Rheumatology and Rehabilitation Department,
Mansoura Faculty of Medicine,
Mansoura University, Mansoura, Egypt;
shmach_237@hotmail.com
This new, single blinded placebo controlled study, conducted by the Faculty of Medicine at Mansoura University, conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain. [1]
The authors concluded that spinal manipulation is effective for the treatment of chronic nonspecific LBP and that to obtain long-term benefit for the patient, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy can provide that additional benefit.
BACKGROUND: Spinal manipulation (SMT) is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP previously, but the efficacy of maintenance SMT in chronic non-specific LBP has never been studied.
In this study, 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized into 3 groups:
- One third of them received 12 treatments of sham SMT over a one-month period.
- One third of them received 12 treatments of SMT during a one-month period, with no follow-up care during the next nine months, and
- One third of them received 12 SMT visits during the first month, followed by “maintenance” SMT every two weeks, for the next nine months.
To determine any difference among these 3 care groups, researchers measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline, and at 1-month, 4-months, 7-months, and at 10-months
RESULTS: Patients in manipulative groups (groups 2 & 3) experienced significantly lower pain and disability scores than the sham group at the end of the first 1-month period.
At the 10-month follow-up, only the maintenance group maintained improvements in pain and disability, while the group that only received 1-months care had reverted to their pretreatment pain and disability levels.
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CONCLUSIONS: This is the first medically managed trial that clearly demonstrates that maintenance care provides significant benefits to those who suffer from chronic low back pain.
This study re-confirms Descarreaux’s virtually identical 2004 JMPT study, which concluded that:
“This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective post-intensive treatment disability levels”.
It also confirms the findings of Dr. Ron L. Rupert, in his ground-breaking 2000 JMPT article, titled: Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II which found that:
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Our Maintenance patients have the greatest results, and have better over all wellness.
RESPONSE from Frank
Birmingham,
That’s been my experience too.
Can you tell us more? Exactly what do YOU mean by “better over all wellness”? What have your patients told you? What have you seen firsthand? Inquiring minds want to know!
Cool Study.
Our friend Dr. Andre Brussard did a little video talking more about this study. http://www.youtube.com/watch?v=eqhKqzLpmoo
I hate to admit this, but this study helps me out tremendously because it give me more confidence to recommend ongoing care for my own patients. It gives me certainty with my care plans.
Todd
I liked that you put the term maintenance in quotes. I’m with the group that prefers “chronic/recurrent” care. Terms aside, I’m glad to see more research that supports it.
Hi Derek
We have published materials on that topic previously:
Chiropractic Reaches Consensus On Terminology For Stages Of Care
I believe the point of this article was to counter Medicare’s aversion to the term “maintenance” as being something unnecessary, or unworthy of remuneration.
As a Medically-biased Chiropractor, I love to read this. Now I have more ammo to support the MC plans I have been somewhat reluctant to “push” on my patients.
RESPONSE from Frank
I hope it’s not a push, but merely a sharing of the fact that people who receive periodic checkups have much lower incidence of relapse.
When patients become asymptomatic, I tell them:
“We’re at that point in your care where you have to make a decision
Currently you are out of pain, so you have the choice to save your money, and wait until it starts hurting again before you return for care. That could be in days, weeks, or months…no one can predict that.
My recommendation is that we reduce the frequency of your visits, while we continue to remodel those tissues (like wearing braces on your teeth) to reduce the risk of it coming back.
What would you like to do?”
It is also best to have periodic checkups to avoid any worse case in the future.
Frank,
I like the way you approach bridging that gap. We take a similar approach in our office. The choice is always the patient’s. However, we do feel they should be informed that they can continue to improve or maintain what they have accomplished by checking back once every month or two (depending on their lifestyle, occupation, etc.). And now, there are some research studies which help support that. It’s fantastic.
-Troy