Do you recommend maintenance care for your low back pain patients? It is well-known that LBP is often recurrent and has a huge negative impact on society; thus, effective preventive strategies are needed. The prevention of chronic conditions can be described as secondary or tertiary, where secondary prevention strategies reduce the impact of existing conditions and tertiary attempts to reduce the impact of conditions that become chronic. One of the strongest predictors of a positive outcome to manual treatments, including spinal manipulation (SMT) for back pain, is when patients report subjective improvement at the fourth visit. These “fast responders” have also been shown to report better outcomes at three and 12 months. Many chiropractors recommend “maintenance care (MC)” to their patients for recurrent and persistent musculoskeletal pain and dysfunction, which qualifies as a form of secondary or tertiary prevention. Typically, such preventive care is delivered in regularly spaced visits over longer periods of time. The use of MC visits as a prevention strategy is common among Scandinavian chiropractors who participated in this study, as well as the general population of chiropractors in this region (and others, of course!). Conversely, other chiropractors who do not use MC may simply discontinue a patient’s care and recommend them to return if the pain recurs. In most cases, clinicians mix these two approaches (i.e. recommending MC versus symptomatic care) depending on an individual patient. Since it is not known which method is most beneficial to patients, the objectives of this study were to compare MC to symptom-guided care by considering: 1) the total number of days with bothersome LBP over 52 weeks, 2) the prevalence of days with pain per week over time as trajectories, and 3) the total number of treatments…finally, a well-designed trial on this topic for us to discuss and share! Please read the full Review so you can discuss this paper effectively with your patients!
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