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Table 1

Return to:   A Theoretical Basis For Maintenance Spinal Manipulative Therapy
For The Chiropractic Profession

Characteristics and results of included studies

AuthorStudy typeStudy populationInterventionsOutcomesResults
Moller et al4SurveyDanish DCsMaint care for the LBP patientTypes of maintenance careSimilar strategies to DCs in different countries
Jamison9SurveyAmerican & Australian DCsMaint careDefinitions of maintenance carePurpose, components, conditions, and perceptions defined
Rupert10SurveyAmerican DCsMaint careAttitudes & practice patternsPurpose, components, conditions, perceptions, income are defined
Rupert et al11SurveyAmerican chiropractic patients >65 y oldMaint care5-y history of maint careTypes of care are defined
Axen et al37SurveySwedish DCsMaint care for LBP patientConsensus of clinical reasoningMaint care is provided to prevent relapses. Past freq of episodes is important in making recommendations. 50% improvement needed to recommend tertiary maint care.
Hansen et al14SurveyDanish DCsMaint care for LBP patientIndications of maint careHx of LBP with a prior response to care is indication for maint care
Sandnes et al15Clinical observations868 patients from 15 Danish and 13 Norwegian chiropractorsChiropractic careFrequency of maint care2-wk to 3-mo intervals
Senna and Machaly17Single blinded placebo controlledChronic nonspecific LBP patientSpinal manipulationPain, disability, patient satisfaction, health statusImproved pain & disability with MMT
Hawk et al18Randomized pilotPatients >65 y oldSpinal and extravertebral manipulationBalance, chronic pain, dizzinessImproved dizziness, pain & disability with extended care
Burton and Tillotson19ObservationalLBP patients <40 y oldMeasurement of sagittal lumbar mobilityPrevalenceReduced mobility in middle-aged patients with sciatica
Burton et al20Observational958 LBP patientsMeasurement of sagittal lumbar mobilityPrevalenceMobility changes in current and past LBP patients
Cramer et al21 (1)Laboratory87 RatsSpinal fixationDegenerationTime-dependent degenerative changes
Cramer et al22 (2)RCT64 Healthy studentsSide posture manipulationSpinal joint responseGapping of the Z-joint
Cramer et al23 (3)Laboratory23 RatsSpinal fixationJoint adhesionsTime of onset of joint adhesions
Cramer et al24 (4)RCT16 Healthy studentsSide posture manipulationMRI measurement of joint gappingGapping of the Z-joint found with manipulat
He and Dishman26Laboratory32 Guinea pigsKnee fixationElectron microscopySpinal motor neuronal degeneration
Kader et al27Retrospective78 Low back & leg pain ptsMRIMultifidus atrophy+ Correlation of atrophy with low back and leg pain
Fahim28LaboratoryRatsImmobilization of ankle & knees to fixate soleusLight microscopeDegeneration of nerve terminals and reversal with remobilization
Lundbye-Jensen and Nielsen29 (1)Observational12 Healthy humansImmobilization of foot & ankleH-reflex & muscle torqueDisuse caused plastic changes in interneuronal circuitry with reversal noted with remobilization
Lundbye-Jensen and Nielsen30 (2)Observational10 Healthy humans1-wk immobilization of wrist & handH-reflex & muscle torqueSpinal and central neuroplastic changes
Brenner et al32Case report1 Low back and thigh pain ptSpinal manipulation and diagnostic ultrasound imagingMultifidus activation with lift taskIncreased muscle activation post-SMT and 1-d post-tx
Pickar33Literature reviewN/ASpinal manipulationNeurophysiological effects of SMTSMT impacts primary afferent neurons, the motor system, & pain.
Descarreaux et al36RCT30 Nonspecific LBP patientsSpinal manipulationPain & disabilityMMT may be beneficial to maintain post acute treatment pain, disability levels
Hx, history; LBP, low back pain; MMT, maintenance manipulative therapy; MRI, magnetic resonance imaging; SMT, spinal manipulative therapy; RCT, randomized clinical trial.