Given this broad definition of health, epistemological constructs borrowed from the social sciences may demonstrate health benefits not disclosed by randomized controlled trials. Health benefits, such as improvement in self-reported quality-of-life (QOL), behaviors associated with decreased morbidity, patient satisfaction, and decreased health care costs, are reported in the following articles, and they make a compelling statement about the effects of chiropractic on general health.
Despite the historic emphasis on treatment, prevention and health promotion are receiving increased attention within the US health care system. These same health promotion tasks are considered by the National Academy of Science and others as essential components of health services delivered by primary care providers. Chiropractors are viewed by many as capable of and actively delivering prevention and health promotion in addition to providing other primary care services.
(eg, soft-tissue and osseous manual procedures and some dietary supplementation).
Previous research demonstrates that the orthodox activities used by primary care medical providers are also used by chiropractors. The concept that chiropractic care is of value in maintaining health and preventing disease began with the work of Palmer.
This preventive treatment is traditionally referred to as maintenance care (MC).
Enjoy this series of articles (mostly by by Meridel I. Gatterman, MA, DC, MEd) as they review how DCs have traditionally counseled patients on health promotion and wellness. You will find these articles most informative!
This page reviews the impact of the chiropractic adjustment on immune function.
Review how proper diet and supplementation can support a healthy lifestyle.
Enjoy this fascinating mini-review of 10 different studies that discuss the improvements that occur when patients receive supportive Maintenance Care.
In patients with recurrent and persistent LBP who responds well to an initial course of manual therapy, Maintenance Care resulted in a reduction in number of days with bothersome LBP per week, compared with symptom-guided treatment. In total, the Maintenance Care group had on average 12.8 fewer days with bothersome LBP over 12 months. The effect of the intervention was achieved at the cost of 1.7 additional visits to the chiropractor. For patients with recurrent and persistent LBP who are selected according to evidence-based criteria, MC should be considered as an option for tertiary prevention.
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.
The Nordic Maintenance Care Program: What Is Maintenance Care?
Chiropractors are more likely to offer MC to patients whose complaints include a significant muscular component. Furthermore, a successful transition to MC appears dependent on correctly matching complaint with management. A positive relationship between chiropractor and patient facilitates the initiation of MC. Finally; MC appears grounded in a patient-oriented approach to care rather than a market-oriented one.
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. 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.
Maintenance Care In Patients With Low Back Pain?
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.
How Close and Who Decides?
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.
There appeared to be consensus among the participants in relation to the rationale for at least four of the management strategies and partial consensus on the rationale for the remaining two. These results confirm that there is a pattern among Nordic chiropractors in how they manage patients with LBP.
The results from the questionnaire in the Danish survey showed that the response pattern for the nine scenarios was similar to that obtained in the Swedish survey. There seems to be relative agreement between chiropractors working in different countries and sampled through different methods in relation to their choice of management strategies in patients with low back pain.
Recommend Secondary and Tertiary Preventive Care For Low Back Pain?
In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care.
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.
Low Back Pain Result in Better Long Term Outcome?
This new, single blinded placebo controlled study, conducted by Mansoura Faculty of Medicine at Mansoura University, conclusively demonstrates that maintenance care (aka Preventive Care) provides significant benefits for those with chronic low back pain.
Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients.
Preventive orientation to health through health promotion is well established. Health promotion provides the opportunity for chiropractic practitioners to promote health through assessment, education, and counseling on topics such as nutrition, exercise, stress reduction, life style patterns, weight reduction, smoking cessation, and ergonomics, among others.
The practice of chiropractic usually deals with acute therapeutic intervention and long-term care plans. This chapter focuses on the latter, which includes wellness or preventative care (designed to reduce the future incidence of illness or impairment) and health promotion (based upon optimal function).
This patient population is demographically diverse. A high proportion of patients who used tobacco, or were overweight or obese expressed interest in information on those topics. A substantial proportion reported being under care with a mental health professional. This clinic provides opportunities for students to work with diverse populations, collaborate with other professions, and practice health promotion.
Coulter and researchers at the RAND Corporation  performed an analysis of an insurance database, comparing persons receiving chiropractic care with non-chiropractic patients. The study consisted of senior citizens >75 years of age. Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the non-chiropractic patients.
In summary, this narrative literature review manifested progressive physiological consequences as a result of joint immobility. When this is correlated with the biomechanical and neurological research finding of manipulative therapy, a line of reasoning arises that generates a theoretical framework for a physiological hypothesis of the basis of MMT. There appears to be a correlation of time intervals of immobility and the onset of joint adhesions, spinal joint degeneration, aberrant Ia neurological input, degeneration of the a-motor neuronal pool, motor end plate degenerative changes, and onset of muscular weakness and atrophy. This correlates with the usual clinical dosage of MMT as shown in clinician surveys in numerous countries and patient satisfaction (Fig 2). The graphic depiction clearly demonstrates that the clinical consensus of dosage of MMT has been found to be most beneficial at an average of once every 2 to 4 weeks. We also see here that it closely correlates with the studies that show onset of facet joint degeneration, neural degeneration, neuroplastic changes, and muscular atrophy and weakness at an average of 2 to 4 weeks.
Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65.
This study found that you are twice as likely to end up disabled if you get your care from a Physical Therapist, rather than from a DC, and that patients were 60% more likely to be disabled if they choose an MD to manage their care, rather than a DC.
One hundred and twenty nine RCTs of spinal manipulation were identified; 12 had adequately reported psychological outcomes. Six trials with a verbal intervention comparator were combined in a meta-analysis, and found a mean benefit from spinal manipulation equivalent to 0.34 of the population standard deviation (S.D.) [95% confidence interval (CI) 0.23–0.45] at 1–5 months; 0.27 of the S.D. [95% CI 0.14–0.40] at 6–12 months. There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.
Patients of low socioeconomic status face barriers to accessing chiropractic services. This study suggests that chiropractic care reduces pain and disability as well as improves general health status in patients with MSK conditions. Further studies using a more robust methodology are needed to investigate the efficacy and cost-effectiveness of introducing chiropractic care into publicly funded health care facilities.
Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system.
SF-36 mean scores of patients from the shelter increased in each of the scales and summary scores. Results must be interpreted cautiously because of the small number of participants, but it is interesting to note that the vitality scale (VT) score improved 22 points. This increase was enough to achieve statistical significance (p equals 0.02) despite the small numbers of patients involved. It appears that chiropractic care holds promise and merits further investigation as one means of enhancing the quality of life in the homeless population studied in this case series report.
The patient appeared to experience improvement in quality of life while showing signs suggestive of improved spinal function. The relationship between indicators of vertebral subluxation and quality of life deserves further investigation using a research design that allows for exploration of possible causal relationships.
(2) that ongoing supportive care can reduce disability levels, as measured by the Oswestry Low Back Pain Disability questionnaire.
The data reviewed lend support to the contention that chiropractic adjustments, often for the purpose of correcting vertebral subluxation, confer measurable health benefits to people regardless of the presence or absence of symptoms. A significant amount of preliminary evidence supports that people without symptoms can benefit from chiropractic care. Improved function can be objectively measured in asymptomatic individuals following chiropractic care in a number of body systems often by relatively non-invasive means. It is plausible that chiropractic care may be of benefit to every function of the body and have the potential for long-term, overall health benefit to those receiving chiropractic care.
You may review many other articles about chiropractic and Asthma.
Six hundred and fifty eight American (44%) and 138 Australian (35%) chiropractors returned completed questionnaires. Maintenance care is perceived to reduce recurrences, to maintain optimal health and provide relief for irreversible conditions. Health benefits are largely achieved by providing chiropractic adjustments, exercise and dietary counselling. Maintenance care is perceived to be particularly effective for managing musculoskeletal problems and stress but is also effective for conditions affecting the respiratory, gastro-intestinal, and to a lesser extent cardiovascular and reproductive systems. Respondents believe that maintenance care should be funded by insurance but recognise the need for further research.
This study indicated that, as a profession, chiropractic has recognized the importance of geriatric education. Several articles indicate that the utilization of chiropractic services of older patients is increasing, and other articles indicate that many different conditions have been successfully resolved by chiropractic care. Although the results of this article are encouraging, continued research is necessary to further develop an evidence-based approach to chiropractic geriatric care, especially in the areas of maintenance care and the management of non-musculoskeletal conditions.
Rupert, Manello, and Sandefur surveyed 311 chiropractic patients, aged 65 years, who had received “maintenance care” for 5 years. Chiropractic patients receiving maintenance care, when compared with US citizens of the same age, spent only 31% of the national average for health care services and reported a 50% reduction in medical provider visits. The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and nonprescription drugs. Furthermore, 95.8% believed the care to be either “considerably” or “extremely” valuable.
A retrospective study conducted in Sweden  has determined that about one in four chiropractic patients experiences some form of "positive nonmusculoskeletal side effect" after spinal manipulative therapy (SMT). In addition, the percentage of patients who experience positive side effects increases with the number of spinal regions adjusted. The Swedish researchers asked all members of the Swedish Chiropractors Association (SCA) to participate in the study. Eighty-one percent of the SCA membership complied. Each doctor of chiropractic gathered data from 20 patients over a three-week period for a total of 1,504 valid patient questionnaires. Patients were included if they had been previously adjusted within the last two weeks for musculoskeletal complaints. The patients were asked if after their previous visit they ìexperienced any positive changes that do not seem to have anything to do with your back problem?
Of the 138 patients attending 1 of 10 participating chiropractic clinics, more than 30% regarded themselves as moderately to severely stressed, and over 50% felt that stress had a moderate or greater effect on their current problem. Some 71% of patients felt it would be helpful if their chiropractic care included strategies to help them cope with stress, and 44% were interested in taking a self-development program to enhance their stress management skills. Patient perceptions are known to be important in health care. A number of chiropractic patients perceive they are moderately or severely stressed. Interventions that reduce stress, or even the patient's perception of being stressed, may be construed as valid, non-specific clinical interventions. It may be timely for chiropractors to actively contemplate including stress management routinely in their clinical care protocols.
Complementary and alternative medicine strategies often offer patients more holistic approaches to health care than traditional disease-specific allopathic models. Chiropractic has historically offered a similar approach to improved health through the use of regular spinal manipulation or adjustments, often termed maintenance care. There is strong anecdotal support of regular spinal manipulation, both from chiropractors and their patients that invites further research to substantiate these claims.
Coulter et al performed an analysis of an insurance database, comparing persons receiving chiropractic care with nonchiropractic patients. The study consisted of senior citizens >75 years of age. Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the nonchiropractic patients.
Most studies of chiropractic efficacy have been limited to low back pain, neck pain or headaches. The notion that chiropractic may enhance one's life experience if used on an ongoing basis has been largely ignored in the literature. In that sense, chiropractic care, aimed at the removal of vertebral subluxation, may be of benefit to a wider proportion of the population, besides those complaining of specific illness or pain. Evidence is needed to justify the use of long-term chiropractic care in a population in which the main goals of care are the advancement of health and human potential rather than the treatment of disease or the alleviation of pain.