The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides?

BACKGROUND: The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC). Thus it is not known if patients on MC are coerced to partake in a program of frequent treatments over a long period of time, or if they are actively involved in designing their own individualized treatment program. OBJECTIVES: It was the purpose of this study to investigate how chiropractic patients with low back pain were scheduled for treatment, with special emphasis on MC. The specific research questions were: 1. How many patients are on maintenance care? 2) Are there specific patterns of intervals between treatments for patients and, if so, do they differ between MC patients and non-MC patients? 3. Who decides on the next treatment, the patient, the chiropractor or both, and are there any differences between MC patients and non-MC patients? METHODS: Chiropractic students, who during their summer holidays were observers in chiropractic clinics in Norway and Denmark, recorded whether patients were classified by the treating chiropractor as a MC-patient or not, dates for last and subsequent visits, and made a judgement on whether the patient or the chiropractor decided on the next appointment. RESULTS: Observers in the study were 16 out of 30 available students. They collected data on 868 patients from 15 Danish and 13 Norwegian chiropractors. Twenty-two percent and 26%, respectively, were classified as MC patients. Non-MC patients were most frequently seen within 1 week. For MC patients, the previous visit was most often 2-4 weeks prior to the actual visit, and the next appointment between 1 and 3 months. This indicates a gradual increase in intervals. The decision of the next visit was mainly made by the chiropractor, also for MC patients. However, the study samples of chiropractors appear not to be representative of the general Danish and Norwegian chiropractic profession and the patients may also have been non-representative. CONCLUSION: There were two distinctly different patterns for the time period between visits for MC patients and non-MC patients. For non-MC patients, the most frequent interval between visits was one week and for MC patients, the period was typically between two weeks and three months. It was primarily the chiropractor who made the next visit-decision. However, these results can perhaps not be extrapolated to other groups of patients and chiropractors.