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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:

Background

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.

(more…)

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

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]. (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.

(more…)

Zen and the Art of Chiropractic Maintenance

By |December 29, 2011|Cost-Effectiveness, Maintenance Care|

Zen and the Art of Chiropractic Maintenance
An Inquiry Into Health Care Values

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic

By Anthony Rosner, PhD, LLD [Hon.], LLC


With all due respect to Robert Pirsig’s classic tome of the 1970s, [1] the book title couldn’t be more appropriately applied to both the state and lack of recognition of chiropractic health care.

As Pirsig explains in his introduction, the book itself isn’t an expostulation on orthodox Zen Buddhist philosophies, or for that matter motorcycles. Rather, it describes a journey with philosophical reflections along the way.

The same might be said of chiropractic’s own journey, in this case seeking proper recognition. In particular, chiropractic from the point of view of a variety of third-party payers has been repeatedly turned down for reimbursement when it comes to matters of maintenance or preventive therapy. Completely counterintuitive, you might say, in light of the repeated and sometimes urgent declarations that we hear to the effect that the only way to control the runaway costs and inefficiency of American health care is to emphasize preventive care, placing it at the highest rather than lowest priority of interventions. [2]

The evidence from recent research clearly demonstrates that the provision of maintenance or preventive measures from chiropractors appears to deliver tangible benefits, with major impacts upon our health care system:

Cost-Effectiveness

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 percent vs. 80.8 percent);
  • free from hospitalizations for the past 23 years (73.9 percent vs. 52.4 percent);
  • more likely to report a better health status;
  • more likely to exercise vigorously;
  • and more likely to be mobile in the community (69.6 percent vs. 46.8 percent).

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 health care interventions. [3] (more…)

General Health, Wellness, and Chiropractic Care

By |September 18, 2011|Maintenance Care, Wellness Care|

General Health, Wellness, and Chiropractic Care

The Chiro.Org Blog


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.

Despite the historic emphasis on treatment, prevention and health promotion are receiving increased attention within the US health care system. These same health promotion tasks are considered by the National Academy of Science and others as essential components of health services delivered by primary care providers. Chiropractors are viewed by many as capable of and actively delivering prevention and health promotion in addition to providing other primary care services. (more…)