Why is Maintenance Care So Important?

Maintenance Care is a term used in health care referring to appropriate care directed toward maintaining optimal body function. In chiropractic this would include following a recommended schedule of regular chiropractic adjustments regardless of whether you are free of symptoms. Many chiropractors will schedule a frequency one to several visits a month every month. Maintenance care is a type of preventative care that is recommended so that recurrences of painful episodes are lessened.

One research study surveyed chiropractors about their use of recommending maintenance care to patients.¹ They found that 98% of responding chiropractors felt that regular chiropractic care would be important for the “average person”.¹

In another survey study, responding chiropractors reported that they agreed the purposes of maintenance care included all of the following (all statements with over 80% agreement):

• minimize recurrence or exacerbation,
• maintain or optimize state of health,
• prevent conditions from developing,
• provide palliative care for “incurable” conditions,
• and determine and treat subluxations

Outside of survey studies that have looked at what chiropractors recommend and why they make those recommendations, more recent research has looked at the clinical benefits of maintenance care. One recent study done by Senna and Machaly³ showed that the disability scores of patients not receiving maintenance care following an intensive treatment plan returned to pre-treatment levels over a 10-month period. Basically, they lost all signs of improvement over the 10 months of receiving no maintenance care. The group that received regular maintenance care had significantly lower disability scores after the same 10-month period.³

A second clinical study by Cifuentes,⁴ looked at nearly 900 workers with low back injuries and followed them for one year. They arrived at a couple of very interesting conclusions:

• “The lowest incidence of repeat injury was found among those workers who had received chiropractic maintenance care.”⁴
• Physical therapy was shown to have the highest percentage of reinjured workers, followed by those receiving standard medical treatment (or no treatment at all).⁴

Finally, and most recently, Ecklund and colleagues⁵ performed a large-scale study with over 2000 eligible patients included in their analysis. They looked at the impact of recommended maintenance care versus recommending patients return as needed. They also made a couple important conclusions:

• “In patients with recurrent and persistent LBP [Low Back Pain] who responds well to an initial course of manual therapy, MC [Maintenance Care] resulted in a reduction in number of days with bothersome LBP per week, compared with symptom-guided treatment.”⁵
• “For patients with recurrent and persistent LBP who are selected according to evidence-based criteria, MC should be considered as an option for tertiary prevention.”⁵

In summary, regular maintenance care is recommended by 98% of practicing chiropractors. And for good reason. Research shows that Maintenance Care works versus no care, as well as being better than recommending a patient return as needed. So, remember to make sure that after you complete a corrective care plan, you should follow through with maintenance care that is recommended. It really is the most important phase of care in order to benefit long-term from correcting your spine.

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REFERENCES:

1. BolinePD, Sawyer CE: Health promotion attitudes of chiropractic physicians. AJCM 1990, 3:71-76.
2. Rupert RL: A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care. Part 1. J Manipulative Physiol Ther 2000, 23:1-9.
3. Senna MK1, Machaly SA. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976). 2011 Aug 15;36(18):1427-37.
4. Cifuentes M, Willetts J, Wasiak R. Health maintenance care in work-related low back pain and its association with disability recurrence. J Occup Environ Med. 2011;53(4):396-404.
5. Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axén 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 Published: September 12, 2018