b'TECHNIQUE Council Is There Good Evidence Supporting Chiropractic Maintenance Care?By Dr. David GraberChair, Council on Technique and Clinical ExcellenceOUR HEALTH Care from chiropractors during the disability episode One of the most energetically discussed topics of practicing chiropractors is the role and value of maintenance care (MC)(therapeutic), during the health maintenance care period, and for our patients. Many doctors believe MC provides significantthe combination of both was associated with lower disability benefits to patients, but others think it doesnt offer any realrecurrence hazard ratios.value. With a wide range of opinions, lets see what some ofIn 2019, Eklund published two studies on maintenance the research says. care. In the first, a large-scale study with over 2000 eligible First, the definition of chiropractic maintenance care aspatients included in their analysis, they looked at the impact were using it is care with a prevention or wellness focus. Theof recommended maintenance care versus recommending goals are to prevent disease, promote health, and to prolongpatients return as needed. They found that during the and enhance the quality of life. MC differs from supportive12-month study period, the MC reported 12.8 fewer days in care, which involves ongoing care for a chronic condition. total with bothersome LBP compared to the control group and MC may include patient education, screening proceduresreceived 1.7 more treatments. Further, he concluded that for to identify prodromal signs and symptoms of a condition,select patients with recurrent and persistent LBP, MC should in-office rehabilitation, home exercise program guidance,be considered as an option for tertiary prevention. (Note: Dr. nutritional counseling, and lifestyle modifications. ForEklund recorded a webinar on this for the ANJC and it can be our purposes, we are going to be looking at the role offound in the archives on the ANJC website). chiropractic adjustments as the primary intervention forIn the second study, Eklund and his colleagues identified the maintenance care visits. psychological profile of those patients most-likely to benefit In 2011, the world-renowned and prestigious journal Spinefrom MC: Patients with non-specific low back pain (LBP). published a paper, Does maintained spinal manipulationThey compared pre-scheduled maintenance patients (every therapy for chronic nonspecific low back pain result in better1-3 months) with call as needed (PRN) symptom-guided long-term outcome? Researchers took 93 patients betweentreatment control group. These were subdivided into three the ages of 20 and 60 who had had chronic nonspecificsub-groups: LBP for at least six months and randomized them into threeAdaptive Copers (AC): Those with lower pain severity; their groups: One group received 12 sessions in one month of shamcondition produced low interference with everyday life, and spinal manipulation (SMT), another received 12 sessions in onethey had low life distress. These patients had a high activity month of actual SMT with no additional treatments, and thelevel and a good sense of life control.last received 12 sessions in one month of actual SMT with oneInterpersonally Distressed (ID): These patients had a high maintenance SMT per month for nine months afterwards. Atdistrust of others, viewed others as responsible for their 10 months follow-up from the start of care, both groups thatproblems, and felt that their spouses or significant others received the actual SMT improved significantly over the shamresponded in a negative way to their pain behavior.SMT group. The group that had received maintenance SMT had significantly lower pain and disability scores than the otherDysfunctional: Patients who had a severe pain, affective actual SMT group that didnt.(emotional) distress; their condition produced a high Also in 2011, a study published in the Journal of Occupationalinterference with everyday life, and they developed numerous and Environmental Medicine on post injury low-back painpain-avoidance coping strategies. They had a low perception patients found support for chiropractic maintenance care. Inof life control and low activity levels.that study, 894 injured workers were followed for one year.They compared each sub-group in both the MC and PRN During that year there were four different types of therapygroups over a 10-month period. They found that the available to the workers: medical management, physicaldysfunctional group with MC had fewer days of pain than the therapy, chiropractic, and no therapy. Episodes of repeatPRN group. The ID had the same number of painful days in disability were recorded during the year following the initialeach. And surprisingly, the AC sub-group of the MC had more injury. The conclusions speak for themselves: days of pain than their PRN counterparts.In work-related nonspecific LBP, the use of healthThese findings suggest that there is a psychological maintenance care provided by physical therapist or physicianconsideration in determining which patients may be better services was associated with a higher disability recurrence thansuited for maintenance care.in chiropractic services or no treatment. In 2019, a systematic review on chiropractic maintenance care 22 I Spring 2020 www.anjc.info'