The Nordic maintenance care program – case management of chiropractic patients with low back pain: A survey of Swedish chiropractors

Iben Axén¹ , Annika Rosenbaum² , Andreas Eklund³ , Laszlo Halasz⁴ , Kristian Jørgensen³ , Peter W Lövgren³ , Fredrik Lange³ and Charlotte Leboeuf-Yde⁵

¹Private practice and the Karolinska Institute, Stockholm, Sweden

²Private practice, Linköping, Sweden

³Private practice, Stockholm, Sweden

⁴Private practice, Lund, Sweden

⁵Research Professor, Nordic Institute for Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, University of Southern Denmark, Denmark[

author email corresponding author email

Chiropractic & Osteopathy 2008, 16:6doi:10.1186/1746-1340-16-6


Published:	18 June 2008

Abstract

Background

Chiropractic treatment for low back pain (LBP) can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care.

Method

The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team.

Results

Replies were received from 59 (60%) of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care.

Conclusion

To a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of LBP.