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
Link: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203029
- Andreas Eklund ,
Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing
* E-mail: andreas.eklund@ki.se
Affiliation Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
⨯
http://orcid.org/0000-0002-2162-7537 - Irene Jensen,
Roles Conceptualization, Investigation, Methodology, Supervision, Writing – review & editing
Affiliation Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
⨯ - Malin Lohela-Karlsson,
Roles Conceptualization, Investigation, Methodology, Supervision, Writing – review & editing
Affiliation Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
⨯ - Jan Hagberg,
Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Writing – review & editing
Affiliation Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
⨯ - Charlotte Leboeuf-Yde,
Roles Conceptualization, Methodology, Validation, Writing – review & editing
Affiliation Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
⨯ - Alice Kongsted,
Roles Conceptualization, Methodology, Writing – review & editing
Affiliations Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
⨯ - Lennart Bodin,
Roles Conceptualization, Formal analysis, Methodology, Writing – review & editing
Affiliation Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
⨯ - Iben Axén
For individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary and tertiary prevention strategies. The aim of this trial was to investigate the effectiveness of MC on pain trajectories for patients with recurrent or persistent LBP.
MethodThis pragmatic, investigator-blinded, two arm randomized controlled trial included consecutive patients (18–65 years old) with non-specific LBP, who had an early favorable response to chiropractic care. After an initial course of treatment, eligible subjects were randomized to either MC or control (symptom-guided treatment). The primary outcome was total number of days with bothersome LBP during 52 weeks collected weekly with text-messages (SMS) and estimated by a GEE model.
ResultsThree hundred and twenty-eight subjects were randomly allocated to one of the two treatment groups. MC resulted in a reduction in the total number of days per week with bothersome LBP compared with symptom-guided treatment. During the 12 month study period, the MC group (n = 163, 3 dropouts) reported 12.8 (95% CI = 10.1, 15.5; p = <0.001) fewer days in total with bothersome LBP compared to the control group (n = 158, 4 dropouts) and received 1.7 (95% CI = 1.8, 2.1; p = <0.001) more treatments. Numbers presented are means. No serious adverse events were recorded.
ConclusionMC was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.
