The Nordic Maintenance Care Program: Does psychological profile modify the treatment effect of a preventive manual therapy intervention? A secondary analysis of a pragmatic randomized controlled trial

Autoři: Andreas Eklund aff001;  Irene Jensen aff001;  Charlotte Leboeuf-Yde aff002;  Alice Kongsted aff003;  Mattias Jonsson aff005;  Peter Lövgren aff006;  Jakob Petersen-Klingberg aff007;  Christian Calvert aff008;  Iben Axén aff001
Působiště autorů: Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden aff001;  Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark aff002;  Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark aff003;  Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark aff004;  Private practice, Lidköping, Sweden aff005;  Private practice, Stockholm, Sweden aff006;  Private practice, Borlänge, Sweden aff007;  Private practice, Falkenberg, Sweden aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Chiropractic maintenance care is effective as secondary/tertiary prevention of non-specific low back pain (LBP), but the potential effect moderation by psychological characteristics is unknown. The objective was to investigate whether patients in specific psychological sub-groups had different responses to MC with regard to the total number of days with bothersome pain and the number of treatments.


Data from a two-arm randomized pragmatic multicenter trial with a 12-month follow up, designed to investigate the effectiveness of maintenance care, was used. Consecutive patients, 18–65 years of age, with recurrent and persistent LBP seeking chiropractic care with a good effect of the initial treatment were included. Eligible subjects were randomized to either maintenance care (prescheduled care) or to the control intervention, symptom-guided care. The primary outcome of the trial was the total number of days with bothersome LBP collected weekly for 12 months using an automated SMS system. Data used to classify patients according to psychological subgroups defined by the West Haven-Yale Multidimensional Pain Inventory (adaptive copers, interpersonally distressed and dysfunctional) were collected at the screening visit.


A total of 252 subjects were analyzed using a generalized estimating equations linear regression framework. Patients in the dysfunctional subgroup who received maintenance care reported fewer days with pain (-30.0; 95% CI: -36.6, -23.4) and equal number of treatments compared to the control intervention. In the adaptive coper subgroup, patients who received maintenance care reported more days with pain (10.7; 95% CI: 4.0, 17.5) and more treatments (3.9; 95% CI: 3.5, 4.2). Patients in the interpersonally distressed subgroup reported equal number of days with pain (-0.3; 95% CI: -8.7, 8.1) and more treatments (1.5; 95% CI: 0.9, 2.1) on maintenance care.


Psychological and behavioral characteristics modify the effect of MC and should be considered when recommending long-term preventive management of patients with recurrent and persistent LBP.

Klíčová slova:

Cancer treatment – Fear – Lower back pain – Pain psychology – Prognosis – Research grants – Sweden – Chiropractic


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