Background: Low back pain (LBP) is a prevalent condition and has been found to be recurrent and
persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care
(MC), aimed towards minimizing recurrence and progression of such conditions. The
indications for recommending MC have been identified in the Nordic countries from
hypothetical cases. This study aims to investigate whether these indications are indeed used
in the clinical encounter.
Methods: Data were collected in a multi-center observational study in which patients consulted a
chiropractor for their non-specific LBP. Patient baseline information was a) previous duration
of the LBP, b) the presence of previous episodes of LBP and c) early improvement with
treatment. The chiropractors were asked if they deemed each individual patient an MC
candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the
association of the patient variables with the chiropractor’s decision.
Results: The results showed that “previous episodes” with LBP was the strongest predictor for
recommending MC, and that the presence of all predictors strengthens the frequency of this
recommendation. However, there was considerable heterogeneity among the participating
chiropractors concerning the recommendation of MC.
Conclusions:The study largely confirms the clinical use of the previously identified indications for
recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the
strongest indicator.
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