The Nordic Maintenance Care Program: Maintenance Care –
What Happens During the Consultation? Observations and Patient Questionnaires
Chiropractic & Manual Therapies 2012 (Aug 10); 20 (1): 25
Marita Bringsli, Aurora Berntzen, Dorthe B Olsen, Charlotte Leboeuf-Yde and Lise Hestbaek
Background: Because maintenance care (MC) is frequently used by chiropractors in the management of patients with back pain, it is necessary to define the rationale, frequency and indications for MC consultations, and the contents of such consultations. The objectives of the two studies described in this article are: i) to determine the typical spacing between visits for MC patients and to compare MC and non-MC patients, ii) to describe the content of the MC consultation and to compare MC and non-MC patients and iii) to investigate the purposes of the MC program.
Method: In two studies, chiropractors who accepted the MC paradigm were invited to assist with the data collection. In study 1, patients seen by seven different chiropractors were observed by two chiropractic students. They noted the contents of the observed consultations. In study 2, ten chiropractors invited their MC patients to participate in an anonymous survey. Participants filled in a one page questionnaire containing questions on their view of the purposes and contents of their MC consultations. In addition, information was obtained on the duration between appointments in both studies.
Results: There were 178 valid records in study 1, and in study 2 the number of questionnaires received was 373. The time interval between MC visits was close to nine weeks and for non-MC consultations it was two weeks. The content of the consultations in study 1 was similar for MC and non-MC patients with treatment being the most time-consuming element followed by history taking/examination. MC consultations were slightly shorter than non-MC consultations. In study 2, the most common activities reported to have taken place were history taking and manipulative therapy. The most commonly reported purposes were to prevent recurring problems, to maintain best possible function and /or to stay as pain free as possible.
Conclusions: The results from these two studies indicate that MC consultations commonly take place with around two months intervals, and that history taking, examination and treatment are as important components in MC as in non-MC consultations. Further, the results demonstrate that most patients consider the goal to be secondary or tertiary prevention.
The FULL TEXT Article
Background:
Present level of evidence
Maintenance care (MC) is a concept well known among chiropractors, although it is poorly defined and rarely studied. A literature review published in 1996 concluded that there was no scientific evidence to support the claim that MC improves health status and recommended that a series of research actions should be taken [1].
A new review carried out in 2008 revealed, among other things, that not only was there still no evidence-based definition of MC but also that although many chiropractors believe in its usefulness, it seems to be less well accepted by patients [2]. This statement was based on one study, in which it was stated that 79% of patients were recommended for MC by their chiropractors but that only 34% of patients elected to receive these services [3]. Nevertheless, MC programs seem to be relatively common with more than one fifth of visits to Scandinavian chiropractors being MC visits [4, 5].
Since then, the effect of MC has been investigated with varying results in one pilot study and two randomized controlled studies. The pilot study included low back pain patients [6] and the two full-scale studies included chronic non-specific neck pain and chronic non-specific low back pain, respectively [7, 8].
In the three studies described above, patients were included based on neck or back pain alone, but apparently without taking into account the underlying rationale for MC. Therefore, there is still a need to describe the use of MC in everyday chiropractic practice and to use this knowledge to design appropriate clinical trials of the effect of MC. It is our opinion that it is necessary first to define the inclusion criteria for this type of treatment and to describe best practice or, at least, most common practice in relation to MC to ensure that clinical studies on the effect of MC are carried out on relevant patient populations and in a manner that best reflects clinical reality.
Spacing between maintenance care consultations
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