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The Nordic Maintenance Care Program: What Is Maintenance Care? Interview Based Survey of Danish Chiropractors

By |August 21, 2013|Maintenance Care, Medical Necessity, Uncategorized|

The Nordic Maintenance Care Program:
What Is Maintenance Care? Interview Based Survey of Danish Chiropractors

The Chiro.Org Blog

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.

There are many similar studies in our new

Maintenance Care, Wellness and Chiropractic Page

From the Full-Text Article:


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].


Participate in a Wellness Care/ Maintenance Care Research Project

By |April 18, 2013|Announcement, Chiropractic Care, Maintenance Care, Wellness Care|

Participate in a Wellness Care/
Maintenance Care Research Project

The Chiro.Org Blog

Wellness care, or “maintenance care,” is widely accepted by the profession as an integral part of chiropractic practice. However, to date, a cause-and-effect relationship between wellness care and improved long-term health outcomes has yet to be clearly demonstrated. This proposed study is designed to add to the evidence base about this important topic.

Purpose of this Study

The purpose of this study is to assess changes in Health-Related Quality of Life over a 12 month period for chiropractic patients who do, or do not participate in wellness care. It is being conducted in the offices of U.S. chiropractors who are members of the Integrated Chiropractic Outcomes Network (ICON).

For this study, we define chiropractic wellness care as a course of long-term care provided to a patient who is either asymptomatic or whose original presenting complaint has been resolved or stabilized, and is provided for the purpose of preventing disease, optimizing function, and supporting the patient’s wellness-related activities and/or minimizing recurrences of previous complaints.

Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD, Marion Willard Evans Jr., DC, PhD, MCHES, Daniel Redwood, DC
Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness

J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 556-567

Study Design

Baseline data are collected in practitioners’ offices; follow-up is conducted by the central office at Logan, by phone and email. Each doctor enrolls 5 consecutive new patients. New patients of any age are eligible! Data are collected at 4 points: first visit and 1, 6 and 12 months later. Outcomes are assessed primarily via questions from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Patients are entered in a drawing for a $100 gift card when they complete the follow-up.

Would You Like to Join Our Study?

We have rolling enrollment so you can still join!

Simply email or call Program Coordinator
Michelle Anderson: or call her at: (636) 230-1946

Principal Investigator: Cheryl Hawk, DC, PhD
Coinvestigators: Katherine Pohlman, DC, MS, U of Alberta
Jay Greenstein, DC, CCSP, private practice
Program Coordinator: Michelle Anderson

You may also want to review our:

Maintenance Care, Wellness and Chiropractic Page

The Impact of Chiropractic Care On Health ~ Why Maintenance Care Makes Sense

By |March 10, 2013|Maintenance Care, Prevention, Wellness Care|

The Impact of Chiropractic Care On Health
Why Maintenance Care Makes Sense

The Chiro.Org Blog

SOURCE:   A Chiro.Org Editorial

Coulter and researchers at the RAND Corporation [1] performed an analysis of an insurance database, comparing persons receiving chiropractic care with non-chiropractic 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 non-chiropractic 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 also reasonably clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions.

There are many more articles like this @ our:

Maintenance Care, Wellness and Chiropractic Page

In another study, Van Breda et al [2] interviewed 200 pediatricians and 200 chiropractors, to determine what, if any, differences were to be found in the health status of their respective children, since their families were being raised under 2 very different health care models.

Read the rest of this Full Text article now!

The Nordic Maintenance Care Program: The Clinical Use of Identified Indications for Preventive Care

By |March 7, 2013|Chiropractic Care, Guidelines, Low Back Pain, Maintenance Care|

The Nordic Maintenance Care Program: The Clinical Use of Identified Indications for Preventive Care

The Chiro.Org Blog

Chiropractic & Manual Therapies 2013 (Mar 6); 21: 10

Iben Axén and Lennart Bodin

Intervention & Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Stockholm 171 77, Sweden

Background   Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter.

Methods   Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the association of the patient variables with the chiropractor’s decision.

Results   The results showed that “previous episodes” with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC.

Conclusions   The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator.

There are many similar studies in our new

Maintenance Care, Wellness and Chiropractic Page

From the Full-Text Article:


In the past few decades, the prevalence of low back pain, LBP, has been found to be extremely high [1] and the resulting costs of the condition are substantial [2] . Upon further scrutiny, the condition has been found to be recurrent in most cases and persistent in some [3-5] . These facts invite preventive approaches, both from a personal and societal perspective. Secondary prevention, to minimize the recurrences or the impact of episodic LBP, and tertiary prevention, to minimize the effects of persistent LBP, seem warranted.


The Nordic Maintenance Care Program: Maintenance Care – What Happens During the Consultation? Observations andPatient Questionnaires

By |August 11, 2012|Chiropractic Care, Maintenance Care, Spinal Manipulation|

The Nordic Maintenance Care Program: Maintenance Care –
What Happens During the Consultation? Observations and Patient Questionnaires

The Chiro.Org Blog

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


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]. (more…)

A Theoretical Basis for Maintenance Spinal Manipulative Therapy for the Chiropractic Profession

By |July 17, 2012|Chiropractic Care, Maintenance Care, Spinal Manipulation|

A Theoretical Basis for Maintenance Spinal Manipulative Therapy for the Chiropractic Profession

The Chiro.Org Blog

SOURCE: J Chiropractic Humanities 2011 (Dec)

David N. Taylor

Director, Multimed Center, Inc., Greenfield, MA

The World Health Organization defines health as being “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. [ 1 ]

Given this broad definition of health, epistemological constructs borrowed from the social sciences may demonstrate health benefits not disclosed by randomized controlled trials.

Health benefits, such as improvement in self-reported quality-of-life (QOL), behaviors associated with decreased morbidity, patient satisfaction, and decreased health care costs, are reported in the following articles, and they make a compelling statement about the effects of chiropractic on general health.

OBJECT:   The purpose of this article is to discuss a theoretical basis for wellness chiropractic manipulative care and to develop a hypothesis for further investigation.

METHODS:   A SEARCH OF PUBMED AND OF THE MANUAL, ALTERNATIVE, AND NATURAL THERAPY INDEX SYSTEM WAS PERFORMED WITH A COMBINATION OF KEY WORDS: chiropractic, maintenance and wellness care, maintenance manipulative care, preventive spinal manipulation, hypomobility, immobility, adhesions, joint degeneration, and neuronal degeneration. Articles were collected, and trends were identified.

RESULTS:   The search revealed surveys of doctors and patients, an initial clinical pilot study, randomized control trials, and laboratory studies that provided correlative information to provide a framework for development of a hypothesis for the basis of maintenance spinal manipulative therapy. Maintenance care optimizes the levels of function and provides a process of achieving the best possible health. It is proposed that this may be accomplished by including chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.