The Nordic Maintenance Care Program: What Is Maintenance Care? Interview Based Survey of Danish Chiropractors
SOURCE: Chiropractic & Manual Therapies 2013 (Aug 20); 21: 27
Corrie Myburgh, Dorthe Brandborg-Olsen, Hanne Albert and
Lise Hestbaek
Institute of Sports Science and Clinical Biomechanics,
Nordic Institute for Chiropractic and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark
Objective To describe and interpret Danish Chiropractors’ perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.
Methods Semi-structured interviews were conducted with 10 chiropractors identified using a stratified, theoretical sampling framework. Interviews covered four domains relating to MC, namely: purpose, patient characteristics, content, and course and development. Data was analysed thematically.
Results Practitioners regard MC primarily as a means of providing secondary or tertiary care and they primarily recommend it to patients with a history of recurrence. Initiating MC is often a shared decision between clinician and patient. The core elements of MC are examination and manipulation, but exercise and general lifestyle advice are often included. Typically, treatment intervals lie between 2 and 4 months. Clinician MC practices seem to evolve over time and are informed by individual practice experiences.
Chiropractors are more likely to offer MC to patients whose complaints include a significant muscular component. Furthermore, a successful transition to MC appears dependent on correctly matching complaint with management. A positive relationship between chiropractor and patient facilitates the initiation of MC. Finally; MC appears grounded in a patient-oriented approach to care rather than a market-oriented one.
Conclusions MC is perceived as both a secondary and tertiary preventative measure and its practice appears grounded in the tenet of patient-oriented care. A positive personal relationship between chiropractor and patient facilitates the initiation of MC. The results from this and previous studies should be considered in the design of studies of efficacy.
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Background
Maintenance care (MC) is used by chiropractors to treat patients who are no longer in an acute state of pain; the purpose being to prevent recurrence of episodic conditions (secondary prevention) and/or maintain a desired level of function (tertiary prevention). The concept is frequently used among chiropractors [1,2] and limited evidence suggests that, among workers with work-related back pain, MC in chiropractic practice appears to decrease the recurrence rate [3]. However, according to two literature reviews, very limited evidence regarding the definitions, purpose and content of MC is currently available [4,5].
As a result, several investigations aimed at increasing and clarifying information on MC have been launched. Specifically, investigators involved with the Nordic Maintenance Care Program have conducted a number of observational, questionnaire-based and qualitative studies, in relation to MC practices for low back pain. The results, thus far, have proven useful in increasing knowledge regarding issues such as usual time intervals between MC treatments [2,6], treatment strategies for different back pain scenarios [1,7,8], the content of MC consultations [6] and patients perception regarding the purpose of MC [6].
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