Maintenance Care

Some chiropractors are very persistent in trying to convert patients to a "wellness or maintenance care" model of care. In other words, having patients come in to receive treatment during times of absolutely zero pain. Current evidence supporting this form of chiropractic therapy is lacking, but luckily for the profession more and more research emerges with each passing year. Until that point, it is very hard to push this type of care on every patient that walks through the front door. The following are some points to be aware of regarding "wellness/maintenence care".

1) This should be determined on an individual basis with the patient making an informed decision to enroll in wellness or maintenance care and this type of care should not be forced onto the patient as part of the
"treatment plan".

2) Some patients with chronic pain syndromes do benefit from periodic manipulation, however there should be a set treatment plan in place with achievable goals (i.e. sustained lower pain levels, keeping the patient eligible to work, etc).

3) Research has shown that maintenance care can be beneficial for some conditions, such as chronic non-specific lower
back pain (meaning lower back pain that is localized in the lower back without radiating into the legs).

Senna MK, Mchaly SA. Does maintained spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome? Spine 2011; 1427-1437.

Descarreaux M, Blouin J-S, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for
chronic low back pain and related disabilities: A preliminary study. Journal of Manipulative and Physiological Therapeutics 2004; 27(8): 509-514.

4) As part of a comprehensive geriatric assessment program, the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were not and found that the individuals under continuing
chiropractic care were:

*Free from the use of a nursing home [95.7% vs 80.8%];
*Free from hospitalizations for the past 23 years [73.9% vs 52.4%];
*More likely to report a better health status;
*More likely to exercise vigorously;
*More likely to be mobile in the community [69.6% vs 46.8%].

Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes
of the cohort of patients experiencing substantially fewer costly healthcare interventions.

Coulter ID, Hurwitz EL, Aronow HU, Cassata DM, Beck JC. Chiropractic patients in a comprehensive home--based geriatric assessment, follow-up and health promotion program. Topics in Clincial Chiropractic 1996; 3(2): 46-55.

5) A second review of a larger cohort of elderly patients across the United States compared direct expenditures
[hospital care, physicians' services, nursing home] between groups of patients who were under maintenance
chiropractic care and those who were not. Nearly a threefold savings of mean annual expenditures was reported as follows:

*$ 3,105 : Maintenance care
*$10,041 : No maintenance care

Rupert RL, Manello D, Sandefur R. Maintenance care: Health promotion services administered to U.S.
chiropractic patients age 65 and older. Journal of Manipulative and Physiological Therapeutics 2000; 23(1): 10-19.

6) One study involving elderly populations reviewed the consequences of implementing an on-site industrial chiropractic program which included the early detection, treatment, prevention and occupational management of musculoskeletal injuries 2 days per week. For the 21 months after implementation of the program, the total number of days of lost time, costs per claim, rate premiums, and especially the number of surgeries decreased dramatically. Cost savings from avoided surgeries alone amounted to $900,000 for these preventive measures.

Cooper SR, Pfefer MT. Development of an on-site industrial chiropractic program. Proceedings of the 9th Biennial Congress of the World Federation of Chiropractic, Vilamoura, PORTUGAL, May 17-19, pp. 202-204.

Clearly there appear to be some benefits related to, and that's the key word, related to chiropractic maintenance manipulation. However, as with any treatment more research is needed in order to make the more broad suggestion that every patient needs maintenance care.