Trial reportPloS one2018
The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial.
Trial report in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Pooled it
- Chiropractic maintenance care - what's new? A systematic review of the literature.Chiropractic & manual therapies · 2019Pooled it
- Development and evaluation of the MAINTAIN instrument, selecting patients suitable for secondary or tertiary preventive manual care: the Nordic maintenance care program.Chiropractic & manual therapies · 2022Trial
- The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain - a secondary analysis of a pragmatic randomized controlled trial.Chiropractic & manual therapies · 2020Trial
- Impact of the MAINTAIN instrument on clinical decision-making for new spinal pain patients: a cross-sectional study.The Journal of the Canadian Chiropractic Association · 2026Article
- Article
- Multi-Institutional Pragmatic Randomized Controlled Trial to Evaluate the Effectiveness of Manual Maintenance Therapy for Chronic Bothersome Neck Pain.Journal of pain research · 2026Article
- Conceptualizing the evidence pyramid for use in clinical practice: a narrative literature review.The Journal of the Canadian Chiropractic Association · 2025Article
- The pathophysiologic mechanisms of spinal manipulative therapy in the management of chronic musculoskeletal pain.The Journal of the Canadian Chiropractic Association · 2025Article
- When there is little or no research evidence: a clinical decision tool.The Journal of the Canadian Chiropractic Association · 2025Article
- A multi-level implementation strategy to increase adoption of chiropractic care for low back pain in primary care clinics: a randomized stepped-wedge pilot study protocol.Chiropractic & manual therapies · 2025Article
- Lack of pragmatic attitude of self-labelled pragmatic trials on manual therapy: a methodological review.BMC medical research methodology · 2024Review
- Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life.Brain sciences · 2024Article
- Compliance with evidence-based radiographic imaging guidelines by chiropractic interns at a chiropractic training program.The Journal of chiropractic education · 2024Article
- Exploration of chiropractic students' motivation toward the incorporation of new evidence on chiropractic maintenance care: a mixed methods study.The Journal of the Canadian Chiropractic Association · 2024Article
- Developing an initial set of quality indicators for chiropractic care: a scoping review.BMC health services research · 2024Article
- Clinical indicators for recommending continued care to patients with neck pain in chiropractic practice: a cohort study.Chiropractic & manual therapies · 2023Observational
- Evidence-based maintenance care among chiropractors in Norway: a cross-sectional survey in the Nordic maintenance care program.Chiropractic & manual therapies · 2023Article
- Factors Associated With Dimensions of Patients' Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study.Journal of chiropractic medicine · 2022Article
- Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses.Journal of clinical medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFor individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary and tertiary prevention strategies. The aim of this trial was to investigate the effectiveness of MC on pain trajectories for patients with recurrent or persistent LBP.
methodThis pragmatic, investigator-blinded, two arm randomized controlled trial included consecutive patients (18-65 years old) with non-specific LBP, who had an early favorable response to chiropractic care. After an initial course of treatment, eligible subjects were randomized to either MC or control (symptom-guided treatment). The primary outcome was total number of days with bothersome LBP during 52 weeks collected weekly with text-messages (SMS) and estimated by a GEE model.
resultsThree hundred and twenty-eight subjects were randomly allocated to one of the two treatment groups. MC resulted in a reduction in the total number of days per week with bothersome LBP compared with symptom-guided treatment. During the 12 month study period, the MC group (n = 163, 3 dropouts) reported 12.8 (95% CI = 10.1, 15.5; p = <0.001) fewer days in total with bothersome LBP compared to the control group (n = 158, 4 dropouts) and received 1.7 (95% CI = 1.8, 2.1; p = <0.001) more treatments. Numbers presented are means. No serious adverse events were recorded.
conclusionMC was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.