There are several challenges that face usage of the term wellness. There appears to be no consensus on the definition of wellness or how it is being used. Wellness is not exclusive to chiropractic, and wellness is not synonymous with health, although is often used that way. Wellness is a societal trend, and chiropractic as a health care profession may be a good fit for this concept. Hopefully, this dialogue will encourage the chiropractic profession to further its philosophical dialogue to resolve these dilemmas.
Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence
In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.
Does Maintained Spinal Manipulation Therapy for Chronic Non-specific Low Back Pain Result in Better Long Term Outcome?
SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.
The value of maintenance care must be demonstrated to substantiate use of this service and for it to be a covered service on par with other preventive care services such as annual physical examinations, colonoscopic examinations, prostate examinations in men, and mammograms in women. The purpose of this discussion was to address MMT, its clinical care, and the body of evidence and to generate theories that might further investigate evidence on the same basis as other common preventive services. Therefore, a theoretical framework was developed based on the grounded theory of the common clinical practice of MMT and its common dosage. This review suggests that there may be a correlation between clinical dosages with the time of onset of pathologies. This article aimed to enlighten the debate between the clinical theories and the scientific evidence, and between the philosophy and science of MMT, while providing a physiological hypothesis of the benefits of and direction for future MMT research.
The same might be said of chiropractic’s own journey, in this case seeking proper recognition. In particular, chiropractic from the point of view of a variety of third-party payers has been repeatedly turned down for reimbursement when it comes to matters of maintenance or preventive therapy. Completely counterintuitive, you might say, in light of the repeated and sometimes urgent declarations that we hear to the effect that the only way to control the runaway costs and inefficiency of American health care is to emphasize preventive care, placing it at the highest rather than lowest priority of interventions.
A Randomised Controlled Trial of Preventive Spinal Manipulation With and Without a Home Exercise Program For Patients With Chronic Neck Pain
This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.
Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness
This document describes the procedures and features of wellness care that, based on this panel’s clinical experience and evidence, represents a reasonable approach to wellness care and disease prevention in chiropractic clinical practice. This living document provides a general framework for an evidence-based approach to chiropractic wellness care. This document is a work in progress that should be refined as new evidence emerges.
There is no evidence-based definition of maintenance care and the indications for and nature of its use remains to be clearly stated. It is likely that many chiropractors believe in the usefulness of maintenance care but it seems to be less well accepted by their patients. The prevalence with which maintenance care is used has not been established. Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown. Therefore, our conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial.
The Nordic Maintenance Care Program – Case Management of Chiropractic Patients With Low Back Pain: A Survey of Swedish Chiropractors
Among those chiropractors who participated in this survey, a clinical management strategy pattern emerged for different cases of LBP. However, there were also subgroups of chiropractors with different practice cultures, sometimes favouring a maintenance care program. The rationale for their clinical decisions needs to be further elucidated, and the results of this study need to be verified in other study populations with a variety of study designs.
The Nordic Maintenance Care Program: When Do Chiropractors Recommend Secondary and Tertiary Preventive Care For Low Back Pain?
The vast majority of Swedish chiropractors believe that chiropractic treatment can prevent relapses of LBP. The decision to recommend secondary preventive care to a patient with LBP is based on the past frequencies of the problem, in the past year and in the past 10 years. In addition, duration of the problem, treatment “effect”, lifestyle, attitude, work conditions and psychosocial factors are considered. In the case of tertiary preventive care, the patient should improve at least 50% for a recommendation to be considered and if the improvement is over 75% the majority of study participants would recommend MC.
The Nordic Maintenance Care Program – An Interview Study on the Use of Maintenance Care in a Selected Group of Danish Chiropractors
The results of the present Danish study supported those of the previous Swedish study. There seems to be a common approach among different types of chiropractors, in relation to the management strategies for patients with low back pain. Maintenance care for low back pain appears to be used in order to prevent further events, in particular with patients who react well to treatment and who have a long history of previous problems. However, there is some conflicting evidence both in relation to whether improvement is necessary and as to whether maintenance care is used mainly to prevent further events or to treat patients with poorer outcome for a prolonged period of time. More information is needed on the indications and treatment program for maintenance care, before studying its clinical validity.
The Nordic Maintenance Care Program: Case Management of Chiropractic Patients With Low Back Pain – Defining the Patients Suitable for Various Management Strategies
In conclusion, our findings do confirm that there is a pattern among Nordic chiropractors in how they manage patients with LBP. Our specific interest was to identify the criteria for maintenance care. At this point in time, we can conclude that the patient’s past history is important but also other factors that may influence the recommendation of maintenance care, such as the doctor-patient relationship, in particular the patient’s attitude to and trust in continued care. However, more information is needed to differentiate the “cut points” for the indications to suggest prolonged care. Also it would be relevant to study further its two main different approaches; the one based mainly on symptoms and the other based mainly (or perhaps exclusively) on the chiropractor’s clinical findings.
The Nordic Maintenance Care Program – Time Intervals Between Treatments of Patients With Low Back Pain: How Close and Who Decides?
In this particular group of chiropractors, MC was used for about one quarter of the patients, ranging from 0% to 100% between clinics. The intervals with which the chiropractors saw their MC patients were distinctly different from that of their non-MC patients. An interval of 1-3 months for the next appointments was most frequently used for MC patients but this depended on the duration since the last treatment. In most cases, the observing student considered that the chiropractor and not the patient took the initiative in arranging the next appointment, regardless of whether it was a MC patient or a non-MC patient. However, it is not known, if these results can be extrapolated to other groups of chiropractors and other types of patients.
The Nordic Maintenance Care Program: What Are the Indications For Maintenance Care In Patients With Low Back Pain? A Survey of the Members of the Danish Chiropractors’ Association
The Nordic Maintenance Care Program: What Are the Indications For Maintenance Care In Patients With Low Back Pain? A Survey of the Members of the Danish Chiropractors’ Association
The Nordic Maintenance Care Program: Maintenance Care – What Happens During the Consultation? Observations and Patient Questionnaires
The results from these two studies indicate that MC consultations commonly take place with around two months intervals, and that history taking, examination and treatment are as important components in MC as in non-MC consultations. Further, the results demonstrate that most patients consider the goal to be secondary or tertiary prevention.
The previously identified indications for recommending MC are indeed being used in the clinicians’ decision-making. When the patient is presenting with a history of back pain (>30 days the previous year), many (=4) previous episodes and definite improvement by the fourth chiropractic visit, the overwhelming majority of clinicians (93%) would consider recommending MC. The strongest indicator for this recommendation was the presence of many previous episodes. However, the model also indicated heterogeneity among clinicians in making this decision.
The results of this study may be used in future studies designed to test the efficacy of MC, in order to include the clinically relevant subgroup of patients.
The Nordic Maintenance Care Program: What Is Maintenance Care? Interview Based Survey of Danish Chiropractors
MC is a common phenomenon in Danish chiropractic practice, considered as both a secondary and tertiary preventative measure and its practice appears grounded in the tenet of patient-oriented care. A positive personal relationship between chiropractor and patient facilitates the initiation of MC. However, successful transition to MC appears to be dependent on a correct matching of complaint and management strategy. Interestingly, chiropractors in this study were more likely to offer MC to patients whose complaints include a significant muscular component.
It remains to be investigated whether MC is actually effective, both for the individual patient and in a societal/economic perspective. This is necessary in order to establish the appropriate role of MC in modern healthcare. The results from this and previous studies should be considered in the design of such studies.
Evidence-based Classification Of Low Back Pain In The General Population: One-year Data Collected With SMS Track
It is now possible and indeed necessary to follow the 45 year old advice by LM Rowe to study LBP as a continuum . In our study, frequent data collection over one year made it possible to identify three substantial subgroups in the general population; those without LBP, those with episodic LBP, and those with persistent LBP. Further subsets were identified.
The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults
This study provides evidence of the comparative effectiveness of chiropractic care relative to medical-only services on the functional health of older adults during acute episodes of back care. Our results are the first to show the importance of examining chiropractic use within an episode of care in traditional practice settings, rather than focusing on visit frequency alone. Moreover, we evaluated the effects of the treatments received during the episodes on ADLs, IADLs, and LBFs, which are critically important measures that inform patients, clinicians, and payers about the benefits and harms of certain treatments relative to others. Given the literature supporting a minimally effective chiropractic treatment level for back problems, this research provides additional support that such therapeutic levels are indeed beneficial in terms of protecting older persons from functional declines and self-rated health over as much as 2 years.
Prevention of Low Back Pain: Effect, Cost-effectiveness, and Cost-utility of Maintenance Care – Study Protocol for a Randomized Clinical Trial
This study protocol describes a randomized controlled clinical trial in a multicenter setting investigating the effect and cost-effectiveness of preventive manual care (chiropractic maintenance care) in a population of patients with recurrent or persistent LBP.Four hundred consecutive study subjects with recurrent or persistent LBP will be recruited from chiropractic clinics in Sweden.
A number of chiropractic patients perceive themselves to be moderately or severely stressed. Almost 3 of 4 chiropractic patients in this study expressed interest in their chiropractor helping them cope with their stress. It may, therefore, be timely for chiropractic practitioners to actively contemplate the extent to which they wish to routinely incorporate stress management in their protocol for clinical care.
Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
On the basis of clinical information provided by the treating chiropractor, most patients receiving MC receive an eclectic variety of therapeutic interventions, which usually include manipulation, exercises, and patient education relative to diet, vitamins, and other health issues. In addition to prevention and health promotion, MC visits are directed at a variety of musculoskeletal, as well as visceral, conditions.
The responses of the 311 patients involved in this study demonstrated a significant positive correlation associated with the patients’ perception of health status and the number of years of MC. Where data related to the health habits of US citizens 65 years of age and over existed, the health habits of patients receiving MC were similar to or better than those of the general population. There were positive correlations with both the decreased use of cigarettes and decreased use of nonprescription drugs and the number of years of MC.
There appears to be a subtle difference in the nature of the doctor-patient relationship that exists between chiropractic patients who receive MC management and chiropractic patients who do not, as well as differences between patients receiving MC and those elderly patients who receive no chiropractic care at all. These differences in patients receiving MC included the number and mix of office visits to various health providers. Patients receiving MC had twice as many contacts with a physician during the year than patients who receive no chiropractic care at all. These doctor-patient contacts are primarily for chiropractic MC care and result in a 50% reduction in medical provider visits. Therefore for these patients receiving MC, chiropractic management appeared to replace medical management rather than be complementary to medical treatment. This contrasts with previous work, which demonstrated that elderly chiropractic patients, including both those who do and those who do not receive MC, actually made more visits to medical providers in addition to their chiropractic visits. The need for hospitalization and the high costs associated with that service were markedly reduced for the patient receiving MC. The total annual cost of health care services for the patient receiving MC was conservatively estimated at only a third of the expenses made by US citizens of the same age. Patients also perceived MC services as highly beneficial to prevention and health promotion. Future research will need to determine whether the positive relationships that are associated with patients receiving MC and extended duration of MC care are directly related to the chiropractic services provided, population differences, or other variables.
A Survey of Practice Patterns and the Health Promotion and Prevention Attitudes of US Chiropractors Maintenance Care: Part I
The chiropractic profession has had a historic interest in and emphasis on health promotion and prevention, often referred to as MC. The literature to date consists primarily of individual opinions that, based on this work, have often misrepresented the motivation, therapeutic components, extent of use, and other elements of MC. The respondents to this survey, like their European and Australian counterparts, strongly believe in the preventive and health-promoting merits of periodic visits for MC. MC is believed to benefit patients of all ages for a wide variety of visceral and musculoskeletal conditions. Belief in the efficacy of MC translates into a high rate of recommendation to patients and a substantial economic impact on chiropractic practice. Although chiropractors with low new patient traffic tended to recommend MC services more often, both chiropractors with low and high new patient traffic believed that MC was valuable for promoting patient health. The recommendation that patients receive MC was also not related to practice income from MC. Therefore the belief in the value of MC appears to be motivated by its potential value to the patient and not for financial gain as some have suggested. Chiropractors concur that MC is not simply administering periodic manipulative treatments but rather that exercise, nutritional, and lifestyle recommendations are equal or nearly equal in importance.
Chronic Pediatric Asthma and Chiropractic Spinal Manipulation: A Prospective Clinical Series and Randomized Clinical Pilot Study
After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. There were no important changes in lung function or hyperresponsiveness at any time. The observed improvements are unlikely to be the result of the specific effects of chiropractic SMT, but other aspects of the clinical encounter that should not be readily dismissed. Further research is needed to assess which components of the chiropractic encounter are responsible for important improvements in patient-oriented outcomes so that they may be incorporated into the care of all asthmatic patients.
Efficacy of Preventive Spinal Manipulation for Chronic Low-Back Pain and Related Disabilities: A Preliminary Study
This study appears to confirm previous reports showing that LBP and disability scores are reduced after spinal manipulation.  It also shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment. Maintenance chiropractic care involving spinal manipulation combined with other treatment modalities (exercises, pain management program) should be investigated. Such combined interventions may have a critical influence on pain, disability, and return to work.
Chiropractic Maintenance Care and Quality of Life of a Patient Presenting with Chronic Low Back Pain
This prospective case report describes one patient’s experience while participating in a chiropractic MC program. Although no causal associations can be made, she appears to have experienced an improvement in quality of life, as measured by 2 different quality of life instruments, while simultaneously experiencing an improvement in spinal function. This topic deserves further investigation with a research design that would allow exploration of causal relationships.
This paper described diverse learning experiences designed to enhance critical thinking skills in the context of wellness. By using various modalities in diverse problem solving formats the classroom, internet and a study guide have been combined to create independent, structured self-learning situations. Results of summative student assessment showed students capable of developing a personalized client wellness program consistent with current thinking in conventional health care. By providing a diversity of critical thinking learning opportunities, the more fundamental of which are compulsory, it is hoped that this unit will contribute to the graduation of chiropractors better prepared to interface as ‘wellness coaches’ or ‘healthy life doctors’ within an evidence based health care system.
Chiropractic Care of Musculoskeletal Disorders in a Unique Population Within Canadian Community Health Centers
In Ontario, chiropractic lies outside of the publicly funded health care system and is primarily accessed by patients with private health insurance coverage or higher household incomes. Including chiropractors in publicly funded primary health care CHC teams helps reduce the burden of chronic MSK pain and disability in those patients of low socioeconomic status who would normally face barriers to accessing chiropractic care. These positive findings should stimulate further, more robust, research into integrating chiropractic care into health centers that serve clients with barriers to health care access.
Psychological Response in Spinal Manipulation: A Systematic Review of Psychological Outcomes in Randomised Controlled Trials
There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.
Public Health, Wellness, Prevention, and Health Promotion: Considering the Role of Chiropractic and Determinants of Health
As health care providers, we must understand how the determinants of health interact with each other so that we may best serve the needs of our patients and communities. Many determinants of health overlap or have a direct influence on one another. Poverty can directly relate to working conditions, physical environment, education, and maternal health. Healthy choices and lifestyles may be influenced by education, physical environment, and social/family networks. We cannot address one health determinant without considering the interaction of the other determinants of health. Various new methods for evaluating how chiropractic and musculoskeletal care can be better investigated, such as through qualitative and population health methods, may assist with obtaining a more clear view of chiropractic’s impact on population health.63, 64 An integrated and holistic approach may assist us to help our communities achieve better health. If we are to make an impact on the health of the population, we must take the time to address the unique characteristics of our patients and the communities that we are serving.