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
Address correspondence and reprint requests to Shereen A. Machaly, MD, Rheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt; E-mail: firstname.lastname@example.org
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. 
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.
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:
“The cost of health care for patients receiving MC in this study was far less than that for patients of similar age in the general population, despite the doubling of physician visits (medical plus chiropractic). The greatest difference in health care costs with patients receiving MC was in the areas of nursing care and, especially, hospital care. This reduced need for hospital and nursing home services has recently been corroborated by the research of Coulter et al.”
Coulter et al (Topics In Clinical Chiropractic 1996) performed an analysis of an insurance database, comparing persons receiving chiropractic care with nonchiropractic patients. The study consisted of senior citizens >75 years of age. Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the nonchiropractic patients.
As part of a comprehensive geriatric assessment program, the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were not and found that the individuals under continuing chiropractic care were:
- Free from the use of a nursing home
[95.7% vs 80.8%];
Free from hospitalizations for the past 23 years
[73.9% vs 52.4%];
More likely to report a better health status; More likely to exercise vigorously; More likely to be mobile in the community
[69.6% vs 46.8%].
Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions.
You may also want to review the:
Wellness and Chiropractic Page for more information on this topic.
1. Does Maintained Spinal Manipulation Therapy for Chronic Non-specific Low Back Pain Result in Better Long Term Outcome?
Spine (Phila Pa 1976) 2011 (Aug 15); 36 (18): 1427-37