The Nordic Maintenance Care Program, a Long Journey That Is Starting to Bear Fruit!

Maintenance Care (MC) has been around for a long time within the chiropractic profession and has become an issue of great debate and conflict. Headed by Professor Charlotte Lebouf-Yde a serious research effort was made to study the procedure. Over the past decade a series of publications under the name the Nordic Maintenance Care Program has been published [1-11]. The purpose of the program has been to identify indications for care, treatment content, frequency of care and to understand the clinical reasoning process among chiropractors in the Scandinavian countries.

The understanding gained from the preliminary studies were used to design a pragmatic clinical trial that mimic current clinical practice. The trial was conducted between 2012 and 2016, and in September 2018 the first in a series of papers investigating the effectiveness, and cost-effectiveness of MC was published in PLOS ONE (open access).

The result show that patients on regular MC for recurrent and persistent low back pain had 13 fewer days of activity limiting pain during 1 year compared to patients who were treated only when they experienced a relapse of pain.

https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0203029

In the short video below the lead author Dr Andreas Eklund summarizes the key findings from the trial.

Upcoming publications will report on effect within subgroups, clinical mechanism and cost-effectiveness. Keep up to date on the WFC reading list for Maintenance Care:

http://www.wfcsuggestedreadinglist.com/maintenance-care.html

Andreas Eklund, MSc(Chiro), PhD

References:

1. Leboeuf-Yde C, Hestbaek L: Maintenance care in chiropractic-what do we know? Chiropr Osteopat 2008, 16:3.

2. Axen I, Rosenbaum A, Eklund A, Halasz L, Jorgensen K, Lovgren PW, Lange F, Leboeuf-Yde C: The Nordic maintenance care program - case management of chiropractic patients with low back pain: a survey of Swedish chiropractors. Chiropr Osteopat 2008, 16:6.

3. Malmqvist S, Leboeuf-Yde C: The Nordic maintenance care program: case management of chiropractic patients with low back pain-defining the patients suitable for various management strategies. Chiropr Osteopat 2009, 17:7.

4. Moller LT, Hansen M, Leboeuf-Yde C: The Nordic Maintenance Care Program-an interview study on the use of maintenance care in a selected group of Danish chiropractors. Chiropr Osteopat 2009, 17:5.

5. Hansen SF, Laursen ALS, Jensen TS, Leboeuf-Yde C, L H: The Nordic maintenance care program: what are the indications for maintenance care in patients with low back pain? A survey of the members of the Danish Chiropractors' Association. Chiropr Osteopat 2010, 18:25.

6. Sandnes KF, Bjørnstad C, Leboeuf-Yde C, Hestbaek L: The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides? Chiropractic & Osteopathy 2010, 18(1):5.

7. Bringsli M, Berntzen A, Olsen DB, Leboeuf-Yde C, Hestbaek L: The Nordic Maintenance Care Program: Maintenance care - what happens during the consultation? Observations and patient questionnaires. Chiropr Man Therap 2012, 20(1):25.

8. Axen I, Bodin L: The Nordic maintenance care program: the clinical use of identified indications for preventive care. Chiropr Man Therap 2013, 21(1):10.

9. Myburgh C, Brandborg-Olsen D, Albert H, Hestbaek L: The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors. Chiropr Man Therap 2013, 21(1):27.

10. Eklund A, Axen I, Kongsted A, Lohela-Karlsson M, Leboeuf-Yde C, Jensen I: Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care - study protocol for a randomized clinical trial. Trials 2014, 15(1):102.

11. Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axen I: The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial. PLoS One 2018, 13(9):e0203029.