• Hjertstrand J
• Palmgren PJ
• Axén I
• Eklund A

• Affiliation / Karolinska Institutet. Department of Learning, Informatics, Management, and Ethics
• Affiliation / Karolinska Institutet. Institute of Environmental Medicine. Unit of Intervention and Implementation Research for Worker Health
• Affiliation / Norwegian Chiropractic Research Foundation
• Affiliation(G) / Norway / Oslo
• Affiliation(G) / Sweden / Stockholm
• Chiropractic / Sweden
• Evaluation Studies as Topic
• Interviews as Topic
• Low Back Pain
• Open Access Document
• Qualitative Research
• Sampling Studies

Background: Low back pain is one of the major causes of disability world-wide. Most back pain sufferers experience pain that is recurrent or persistent, making management of this condition a priority. In a series of previous studies, chiropractic maintenance care has been found to be an effective way of reducing the number of days with pain, particularly for patients with a certain psychological profile. However, little is known about patients’ experience of this kind of management plan. This study aimed to explore patient experiences and preferences by looking at barriers to and facilitators of engaging in and maintaining a care plan, and to contrast the data using psychological sub-groups.

Methods: In this qualitative study we performed semi-structured interviews with 24 patients who had previously participated in a Swedish trial evaluating maintenance care. They were purposefully selected to obtain richness, variation and breadth of data. The data were analyzed using inductive qualitative manifest and latent content analysis. We used the theory of planned behavior to deepen our understanding of the constructed themes.

Results: The analysis resulted in two overarching dimensions: “when maintenance care is of high value” and “when maintenance care is of low value”. Four factors were jointly identified as obstacles to maintenance care by patients in all the psychological subgroups. These factors were: Cost demanding, A sense of low value, Perceived as unavailable and Fear of treatment. The one factor seen as facilitating maintenance care by patients in all the subgroups was Care that is patient-centered.

Conclusions: The findings reveal a variance of both positive and negative experiences of MC in the psychological subgroups. These findings can deepen our understanding of how patients experience MC and can help clinicians to understand when patients might regard maintenance care as being of high value.

Author keywords: Chiropractic - Maintenance care - Low back pain - Qualitative study - Purposeful and maximum variation sampling strategy - Semi-structured interviews - Inductive approach

Author affiliations: JH, IA, AE: Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; PJP: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; AE: ELIB, The Norwegian Chiropractic Research Foundation, Oslo, Norway
Corresponding author—andreas.eklund@ki.se

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