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01.12.2010 | Research | Ausgabe 1/2010 Open Access

Chiropractic & Manual Therapies 1/2010

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

Chiropractic & Manual Therapies > Ausgabe 1/2010
Signe F Hansen, Anne L S Laursen, Tue S Jensen, Charlotte Leboeuf-Yde, Lise Hestbæk
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1746-1340-18-25) contains supplementary material, which is available to authorized users.

Authors' contributions

SHF and ALSH designed the study, collected and analyzed the preliminary data and wrote a report on part of the results as a part requirement for their masters degree in Health Sciences (Biomechanics), supervised by CLY and LH. TSJ supervised and assisted with the data analysis. CLY and LH were responsible for the final manuscript. All authors read and approved the final manuscript.



Maintenance care (MC) is relatively commonly used among chiropractors. However, factual information is needed on its indications for use.


This study had two objectives: 1) to describe which role patients' past history and treatment outcome play in chiropractors' decision to use MC in patients with low back pain, 2) to investigate if the chiropractors' clinical/educational background has an effect on the frequency of using MC and their indications for use of MC.


An anonymous questionnaire was sent to all 413 chiropractors practising in Denmark. Its main part consisted of 3 sets of 4 questions relating to one basic case of low back pain. For each case, the chiropractors were asked if they would use MC as they self-defined the term (no/perhaps/yes). There were questions also on gender, age, educational and clinical background, and on the number of MC patients seen by these chiropractors. Their decision to recommend MC was reported. Associations between the demographic variables and 1) the frequency of MC-use and 2) their indications for use of MC were tested through multivariate analysis.


The response rate was 72%. Non-indications for MC were: 1) a good outcome combined with no previous events, or 2) a past history of LBP and gradual worsening with treatment. Indications for MC were a good outcome combined with a previous history of low back pain between once a month and once a year. The mean proportion of MC patients per week were 22% (SD 19), ranging from 0% to 100%. The use of MC was highest among experienced chiropractors, those who were educated in North America, and clinic owners. However, in Denmark most chiropractors graduated before 1999, are educated abroad, whereas most chiropractors thereafter are educated in Denmark. Therefore, we cannot conclude whether this difference relates to education or years of experience. There were no associations detected between demographic variables and the indications for MC.


There is relatively high consensus on when MC should and should not be used. A history of prior low back pain combined with a positive response to treatment encourages the use of MC, whereas no previous history of back pain or a worsening of symptoms discourages the use of MC. There seems to be a difference in the proportional use of MC between chiropractors with more experience educated in North America and those with less experience educated in Denmark.
Additional file 1: Questionnaire. A copy of the questionnaire used in the survey about the use of maintenance care in Danish chiropractic practice. (DOC 34 KB)
Authors’ original file for figure 1
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