The concept of spinal pain as a recurring disorder is gaining wider acceptance. Acute episodes may be short-lived, but the condition is often life-long, featuring periods of exacerbation and remission. Therefore, it may be prudent to shift the treatment focus from overtly curing the condition to managing pain trajectories and individual episodes.
Chiropractors have used the term “Maintenance Care” both to describe ongoing treatment beyond reduction of symptoms and also to describe treatment as a precaution to keep patients healthy, regardless of symptoms or historic factors. The former has been criticized due to a lack of evidence and a potential financial motive, while the second, although logical, also lacks scientific support.
Two previous narrative reviews from 1996 and 2007 concluded that there was no evidence-based definition of maintenance care and the indications for and nature of its use had not been clearly stated. As well, while many chiropractors seemed to believe in the usefulness of maintenance care, little evidence was available as to how it was accepted by patients. Further, the prevalence of use, efficacy and cost-effectiveness of maintenance care for various conditions was unknown. Based on these limitations in the data, “The Nordic Maintenance Care Program” (a research program we’ve Reviewed previously on RRS Education), was launched in order to increase the knowledge surrounding maintenance care.
This new systematic review aimed to address the shortcomings in the previous research by:
  1. defining the idea of maintenance care and the indications for its use;
  2. describing chiropractors’ belief in maintenance care and patients’ acceptance of it;
  3. establishing the prevalence of maintenance care among chiropractors and potential characteristics of the chiropractors who use it; and
  4. determining the efficacy and cost-effectiveness of maintenance care for various conditions.
NEW THIS WEEK: “Chiropractic Maintenance Care – Literature Review” (featuring invited commentary by Dr. Iben Axén - lead study author)
This paper was published in Chiropractic and Manual Therapies (2019) and this Review is posted in Recent Reviews, Maintenance Care, Low Back Pain, Lumbar Spine - Manipulation/Mobilization and the 2020 Archive.
Commentary from Dr. Iben Axén (lead author):

In the interest of evidence-based medicine, we have an obligation to scrutinize the methods that are utilized by chiropractors. If they are effective, we should promote them, if not, we should stop doing them. Sometimes the answer (to the question of effectiveness) may be less than crystal clear, as we are dealing with multifactorial conditions (such as pain) and very heterogeneous patient groups.

Maintenance Care is a management strategy that is commonly used by chiropractors world-wide. Still, a systematic review conducted in 2008 concluded that we knew very little about this way of treating patients: For whom is it recommended? For what conditions? What are the components of such a strategy and what is the frequency of care? How do chiropractors reason around this concept? Is it accepted by patients? Is it effective? Is it cost-effective?

We have now re-done the systematic review from 2008, and we found that the evidence-base of maintenance care has increased considerably. Through studies using many different methods (interviews, surveys, focus groups and randomized trials) we now have a clearer picture of what maintenance care is and how it is utilized. As is often the case, we cannot recommend this strategy for all, but there are some indications of effectiveness for a select group of patients.

Iben Axén, DC, PhD. Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine (IMM) Karolinska Institutet, Stockholm, Sweden. Research leader of the Norwegian Chiropractic Foundation ELiB (Et Liv I Bevegelse = a life in movement).
maintenance care