MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

‘Chiropractic economics’ might be when chiropractors manipulate their bank accounts or tax returns, I thought. But, no, it is a publication! And a weird one at that – it even promotes the crazy idea of maintenance care:

The concept of chiropractic maintenance care has evolved significantly. Initially seen as a method for managing chronic pain, it now includes a broader range of patients and focuses on overall wellness. Modern maintenance care aims to keep patients healthy regardless of their symptoms or history, alleviating and preventing pain through regular, prolonged care. This approach is largely preventive, serving as both secondary and tertiary care.  Studies show chiropractic maintenance care often includes diverse treatments such as manual therapy, stress managementnutrition advice and more, with flexible intervals typically around three months. This evolution underscores the importance of evidence-based, individualized patient care. This article shares the evolution of chiropractic maintenance care, looks at what a modern maintenance care appointment can include and explores best practices for DC maintenance care in 2024. 

Knowledge of chiropractic maintenance care has evolved over the years. In the past, maintenance care in the chiropractic world was often viewed as a way to keep patients going; particularly those suffering from chronic conditions that needed routine care for pain management and prevention. In the last several years, chiropractic maintenance care has changed; no longer does it only involve pain prevention and management for those with chronic conditions. It now encompasses all sorts of patients; no matter their history, symptoms or reasons for seeking a DC…

An interview study of Danish chiropractic care showed maintenance care sessions included a range of treatment modalities, including manual treatment and ordinary examinations alongside multiple packages of holistic additions, like stress management, diet, weight loss, advice on ergonomics, exercise and more. In other anecdotal accounts, chiropractic maintenance care seemed to follow a more traditional guideline of lower back pain management and adjustment. The study hypothesized that maintenance care could also help patients from a knowledge perspective, stating, “DCs could obviously play an important role here as ‘back pain coaches,’ as the long-term relationship would ensure knowledge of the patient and trust towards the DC.” 

Researchers found that three-month intervals were the most common spacing of maintenance care treatments for patients. Most commonly, patients sought or scheduled chiropractic maintenance care over the course of one to three months.  

Chiropractic maintenance care has evolved past simply being a method of ongoing chronic pain management. Today’s patients want to achieve overall wellness, and regular trips to their DC can become a part of that if you work to transition patients into a wellness plan after their acute phase of care is over. 

_____________________________

The author of this article seems to have forgotten two little details:

  1. Chiropractic maintenance care is not supported by sound evidence, particularly in relation to economics (even the above cited paper stated: “We found no studies of cost-effectiveness of Maintenance Care”).
  2. Chiropractic maintenance only serves one economic purpose: it boosts the chiropractors’ income.

Yes, easy to forget, particularly if your name is ‘Chiropractic Economics’.

And also easy to forget that maintenance care would, of course, require informed consent. How would that look like?

Chiro (C) to patient (P):

If you agree, we will start a program that we call maintenance care.

P: Can you explain?

C: It consists of regular sessions of spinal manipulations.

P: That’s all?

C: No, I will also give you advice on keeping fit and living healthily.

P: Why do I need that?

C: It’s a bit like servicing your car so that it works reliably when you need it.

P: Is it proven to work?

C: Yes, of course, there are tons of evidence to show that a healthy life style is good for you.

P: I know, but I don’t need a chiro for that – what I meant do the manipulations keep my body healthy even if I have no symptoms?

C: The evidence is not really great.

P: And the risks?

C: Well, yes, if I’m honest, spinal manipulations can cause harm.

P: So, to be clear: you ask me to agree to a program that has no proven benefit and might cause harm?

C: I would not put it like that.

P: And how much would it cost?

C: Not much; just a couple of hundred per year.

P: Thanks – but no thanks.

28 Responses to ‘Maintenance care’ is very good for chiropractic economics … but not for anything else!

  • As happens often, you oversimplify things and miss the point, however, it does not seem like you care much for the point at all…

    1. you minimize chiropractic to spinal manipulation which shows a complete lack of understanding.
    2. maintenance care for most patients is irrelevant and for some patients, it is a must.
    3. I don’t have time in my diary for maintenance care, but you can sometimes not avoid it.
    4. I am sure you would like to congratulate the Israeli MOH that this week started implementing the Chiropractic Act!!!

    • any evidence – or just wishful thinking again?

      • There is evidence but that is not the point I argue…

        1 – Most pt. don’t need maintenance care, I rather they go exercise and spend their time and money elsewhere.

        2 – I am surprised you spend 5 min on reading “chiropractic economics” I never did so in 22 years.

        3 – A true case from yesterday morning… 77 yoa lady with IDDM, congestive heart failure and adult scoliosis with neurogenic claudication to her left leg. My colleague suggested TLIF L3-L5 with posterior fusion L1-L5 but for obvious reasons prefers not to. She gets partial relief from chiropractic care so she maintains walking and ADL, she comes in for a treatment every two weeks… should I deny her care because its “maintenance”?

        4 – Once again I will state that SMT is an important technique but it’s not “chiropractic care” and it’s not for everyone.

        • what a lot of BS!

          • Can you answer the point?

          • you don’t have a point.

          • iits a very clear point – patients with structural deformities that you can only temporary alleviate pain and suffering needs and requires maintenance care. Denying them care is UNETHICAL and you should reconsider the claims you have made.

            as I stated you oversimplify the issue.

          • no, you miss the point that MC is promoted for people who have NOTHING wrong with them.

          • Maintenance care: given to people with chronic illnesses to maintain or slow a decline in their health or function. https://www.medicareinteractive.org/glossary/maintenance-care

            Preventive care: Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. https://www.healthcare.gov/glossary/preventive-services/

          • I am not speaking of some silly definition but of how MC is advertised and used in practice. Go on the Internet and have a look!

          • oh, I am aware how MC is promoted in the profession. That doesn’t mean they are using the term correctly.

            “The definitions of maintenance care that we found were not based on scientific evidence of the clinical validity of maintenance care but perhaps more on opinion and consensus.”

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396648/

            Thus an accepted definition outside the profession needs to be used. I provided one. But whatever.

          • Also stated in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396648/

            Although it appears perfectly logical to use maintenance care in chronic and recurrent conditions, when informally discussing this phenomenon with chiropractors, we have often detected either a disinclination to discuss, or an ardour of arguments, often resulting in an embarrassing change of subject…

            This might be because the indications for treatment in asymptomatic patients depend solely on tests and observations, such as palpation findings, none of which has been shown to be clearly valid.

            Maintenance care in chiropractic – what do we know?
            Charlotte Leboeuf-Yde and Lise Hestbæk
            Nordic Institute of Chiropractic and Clinical Biomechanics, part of Clinical Locomotion Science, University of Southern Denmark, Forskerparken 10, DK-5230 Odense M, Denmark
            Chiropr Osteopat. 2008; 16: 3.
            PMCID: PMC2396648

  • Maintenance for a car prolongs its life.
    Chiropractic “maintenance” shortens life.

    • ama: Chiropractic “maintenance” shortens life.

      So overall these shorten life?

      manual therapy, nutrition advice, stress management, diet, weight loss, advice on ergonomics, exercise.

      • DC wrote:
        “manual therapy, nutrition advice, stress management, diet, weight loss, advice on ergonomics, exercise.”

        Nutrition advice is not the business of a chiropractor

        Stress management is not the business of a chiropractor

        Diet, weight loss, advice on ergonomics, exercise is not the business of a chiropractor.

        • So instead of defending your claim you elected to state a different claim. I’m not surprised.

        • “Nutrition advice is not the business of a chiropractor”

          Actually, it is. Big business. Many chiropractors (possibly the majority, but I don’t know for sure) sell vitamins & other supplements to their customers.

          When & where nutrition weaseled its way into the chiro world is a mystery to me. They do many things they’re not trained or qualified for & their version of “nutrition” is near the top of the list. They’re no more qualified in the field than is a clerk at a health food store.

          • Thank you for pointing that out, Kurt. It’s just one of the elements of their bait-and-switch business model.

            “They’re no more qualified in the field than is a clerk at a health food store.”

            Indeed…

            Dara Ó Briain Talks Funny: Live in London (2008)

            Here’s my favorite little fact. If anyone is ever described to you as a nutritionist, just be slightly wary, right? What they’re saying may be perfectly true, but “nutritionist” isn’t a protected term. Anyone can call themselves a nutritionist. “Dietician” is the legally protected term. “Dietician” is like “dentist”, and “nutritionist” is like “tooth-i-ologist.”

            ‘Nutrition advice’, diet, weight loss, from a cosplay Doctor of Charlatanry. What could possibly go wrong?

            Choosing the right person to seek help and advice from can sometimes be a confusing task. Many people claim to be experts in nutrition yet have very limited knowledge and offer no protection to the public.

            Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard.

            https://www.bda.uk.com/about-dietetics/what-is-dietitian/dietitian-or-nutritionist.html

          • I think you need to look up the definition of nutrition

  • Yes…”maintenance, maintenance, maintenance”, Sandy’s Chiropractor would often advocate as the best way for my wife to prolong her incredible good health!

    Pick up our book “Blink: Life After Locked-In Syndrome” and see how that advice worked out.

    It should be listed in the horror section.

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