ARTICLE
New evidence regarding the natural course of spinal pain should lead to a shift in treatment approaches. Previously, low back pain (LBP) and neck pain (NP) were thought to be self-limiting ailments, hardly worthy of attention. Gradually, the fact that spinal pain is a recurring disorder is gaining acceptance. The acute episode of spinal pain, similarly to an episode of asthma, may be short-lived, but the condition is often, as for asthma, life-long. With this new understanding of spinal pain as a condition with exacerbations and remissions throughout life, it might be wise to shift the focus of treatment from cure of the condition to management of pain trajectories. Chiropractors appear to have been in the forefront in this domain. Maintenance Care is a well-known concept in the chiropractic profession, describing continued care beyond that of reducing symptoms. Such approaches have been criticized for lack of evidence. Interestingly, although the term Maintenance Care has been used for many decades and by chiropractors all over the world, there seemed to be no official definition nor any knowledge regarding its clinical usefulness. Maintenance Care is a traditional chiropractic approach, whereby patients continue treatment after optimum benefit is reached. A systematic research program in the Nordic countries was undertaken to uncover the definition, indications, prevalence of use and beliefs regarding Maintenance Care to make it possible to investigate its clinical usefulness and cost-effectiveness. As a result, an evidence-based clinical study could be performed. This study concluded that knowledge of chiropractic Maintenance Care has advanced. There is reasonable consensus among chiropractors on what Maintenance Care is, how it should be used, and its indications. Presently, Maintenance Care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain, who report a good outcome from the initial treatments. It appears to be superior to “as needed” care. However, these results should not be interpreted as an indication for Maintenance Care on all patients, who receive chiropractic treatment. Using the search terms “chiropractic OR manual therapy” AND “Maintenance Care OR prevention”, PubMed and Web of Science were searched, and the titles and abstracts reviewed for eligibility, starting from 2007. In addition, a search for “The Nordic Maintenance Care Program” was conducted. Because of the diversity of topics and study designs, a systematic review with narrative reporting was undertaken. Fourteen original research articles were included in the review. Maintenance Care was defined as a secondary/tertiary preventive approach, recommended to patients with previous pain episodes, who respond well to chiropractic care. Maintenance Care is applied to approximately 30% of Scandinavian chiropractic patients. Four studies investigating the effect of chiropractic Maintenance Care were identified, one of these studies found that Maintenance Care patients experienced fewer days with low back pain compared to patients invited to contact their chiropractor ‘when needed’. Source: https://chiro.org/wordpress/2019/11/chiropractic-maintenance-care-whats-newa-systematic-review-of-the-literature/