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RESEARC H Open Access
The Nordic maintenance care program: what are
the indications for maintenance care in patients
with low back pain? A survey of the members
of the Danish Chiropractors’Association
Signe F Hansen
1
, Anne L S Laursen
1
, Tue S Jensen
2
, Charlotte Leboeuf-Yde
1,3
, Lise Hestbæk
1,3*
Abstract
Background: Maintenance care (MC) is relatively commonly used among chiropractors. However, factual
information is needed on its indications for use.
Objectives: This study had two objectives: 1) to describe which role patients’past history and treatment outcome
play in chiropractors’decision to use MC in patients with low back pain, 2) to investigate if the chiropractors’
clinical/educational background has an effect on the frequency of using MC and their indications for use of MC.
Method: An anonymous questionnaire was sent to all 413 chiropractors practising in Denmark. Its main part
consisted of 3 sets of 4 questions relating to one basic case of low back pain. For each case, the chiropractors
were asked if they would use MC as they self-defined the term (no/perhaps/yes). There were questions also on
gender, age, educational and clinical background, and on the number of MC patients seen by these chiropractors.
Their decision to recommend MC was reported. Associations between the demographic variables and 1) the
frequency of MC-use and 2) their indications for use of MC were tested through multivariate analysis.
Results: The response rate was 72%. 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. The mean proportion
of MC patients per week were 22% (SD 19), ranging from 0% to 100%. The use of MC was highest among
experienced chiropractors, those who were educated in North America, and clinic owners. However, in Denmark
most chiropractors graduated before 1999, are educated abroad, whereas most chiropractors thereafter are
educated in Denmark. Therefore, we cannot conclude whether this difference relates to education or years of
experience. There were no associations detected between demographic variables and the indications for MC.
Conclusions: There is relatively high consensus on when MC should and should not be used. A history of prior
low back pain combined with a positive response to treatment encourages the use of MC, whereas no previous
history of back pain or a worsening of symptoms discourages the use of MC. There seems to be a difference in
the proportional use of MC between chiropractors with more experience educated in North America and those
with less experience educated in Denmark.
* Correspondence: l.hestbaek@nikkb.dk
1
Institute of Clinical Biomechanics, University of Southern Denmark, Odense,
Denmark
Full list of author information is available at the end of the article
Hansen et al.Chiropractic & Osteopathy 2010, 18:25
http://www.chiroandosteo.com/content/18/1/25
© 2010 Hansen et al; licensee Bi oMed Central Ltd. This is an Open Access ar ticle distributed under the terms of the Creative Commons
Attribution L icense (http://creati vecommons.org/licenses/by/2.0), which perm its unrestricted use, di stribution, and reproduction in
any medium, provided the original work is properly cited.
Background
Presently, it is not known if or how low back pain (LBP)
can be prevented from developing. Because LBP fre-
quently is a long-lasting or recurring problem, preven-
tion of recurrences is as relevant as primary prevention.
However, also this aspect is clouded in mystery.
Many patients with LBP will seek care from chiroprac-
tors [1,2]. Some patients will continue treatment after
the acute problem has been resolved or considerably
improved, because by then it appears logical to attempt
to attend to the underlying cause of the recurring LBP
complaint. Among chiropractors, this approach is called
maintenance care (MC).
The majority of patients with LBP who are treated by
chiropractors will receive spinal manipulation. Spinal
manipulative therapy has been tested in a number of
trials and found to be effective for LBP, at least in the
short term [3,4]. Whether such treatment can prevent
LBP from recurring or getting worse, however, appears
only to have been tested explicitly in one pilot study,
with inconclusive results [5]. Therefore, it is not known,
if MC is an effective method for preventing, delaying, or
mitigating recurrent episodes of LBP.
Nevertheless, this concept is fairly well accepted
among chiropractors. Chiropractors in various parts of
the world state that they use MC in about one third of
their patients [6-9]. However, the indications for MC, as
it is used today, have not been determined.
Presently, a research program is being conducted in
the Nordic countries trying to illuminate the use of, the
indications for, and the efficiency of MC. So far, it has
been determined, that there is a large degree of consen-
sus among Nordic chiropractors that the primary goal
of MC is prevention of new episodes of LBP, although
for some patients it can be prevention of deterioration
[10,11]. There is also general agreement, that the two
most important issues for recommending MC are fre-
quency of episodes in the past and effect of the treat-
ment. Thus, more previous episodes indicate a higher
risk of recurrence and therefore a larger need for treat-
ment,andtherehastobeapositiveresponsetotreat-
ment if a MC-strategy is to be recommended [7,10-12].
However, despite the large degree of consensus, there is
not total agreement and there are subgroups of chiro-
practors with different opinions.
Since prior history of LBP episodes, and positive
response to treatment have been identified as commonly
accepted indications for offering MC to patients, we
designed this current study to explore this finding in
more specific detail. We asked chiropractors in this
pragmatic cross-sectional survey about their use of MC,
as they self-defined the term, by presenting them with a
series of clinical case scenariosthatvariedastoprior
history (frequency and duration of the previous epi-
sodes) and response to treatment.
In addition we were curious to see, if there were other
factors that would influence chiropractors’use of MC.
In a previous study from Australia, it had been shown
that MC was more common among practitioners who
had only few new patients as compared to those who
had more new patients [13]. Other factors that we
thought could influence chiropractors’incentive to use
MC were: gender (women perhaps being more caring
than men), educational background (some chiropractic
institutions being reputed for encouraging the use of
MC), clinical experience (own experience might either
encourage or discourage its use), and whether
the respondent was a clinic owner or not (financial
incentives).
This study had two objectives: 1. to describe which
role patients’past history and treatment outcome play
in chiropractors’attitudes to the use of MC in patients
with LBP, and 2. to investigate if the chiropractors’
demographic, clinical and educational background has
an influence on how many patients receive MC and
what type of patients are offered MC.
Method
The survey
A list of actively practising chiropractors was obtained
from the Danish Chiropractors’Association. These were
mailed a questionnaire plus a pre-stamped envelope in
February 2007. In order to encourage participation,
information on the study was given to participants at
local chiropractic meetings across the country by two
chiropractors and in the Danish chiropractors’profes-
sional journal. The questionnaires were returned
anonymously.
The questionnaire
A questionnaire was designed specifically for the pur-
pose of this study (Additional file 1). The first page con-
sisted of demographic questions and information on the
number of MC patients as they self-defined the term.
The main part of the questionnaire consisted of three
separate pages each with 4 questions relating to one
basic case, in which an uncomplicated patient with LBP
was described. The basic case was:"A 40-year old man
consults you for low back pain of 2 days duration with
no additional spinal or musculoskeletal problems, and
with no other health problems. His x-rays are normal
for his age. There are no red flags and he seems to be
in good shape both physically and psychologically.
There are no aggravating factors at work or at home.”
The questions about this patient were constructed such
that he was assumed to have received chiropractic
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treatment but that his past history could vary as could
the outcome of the treatment.
The second page of the questionnaire related to this
basic case, on this page presented as a patient who had
no previous history of back problems at all but here
were four different outcomes. On the third page, there
was a history of recurring problems but the outcomes
were the same as on the second page. On the fourth
page, there were four different past histories but the
outcomes were the same. Each of these 12 cases was fol-
lowed by the question:"Would you consider recom-
mending maintenance care? No/Perhaps/Yes“.
The questionnaire was tested a number of times
among researchers and clinicians at the Back Research
Center, in Ringe, Denmark, and improved to ensure face
validity and user friendliness.
Scandinavian mainstream chiropractic practice
Based on previous studies [7,10-12] and in-depths inter-
views with 10 Danish chiropractors (not yet published)
we derived clinical parameters as operational definitions
for the term"Scandinavian mainstream chiropractic prac-
tice”that we applied during our analyses and presenta-
tion of data collected in this current study. Using these
operational definitions, we tried to identify those survey
responses, which were most likely to be expected as
answers to the 12 questions relating to the indications
for the use of MC. For example, within this definition, it
wasconsideredunsuitabletoofferMCtopatientswith
no previous history of back problems at all, whereas
patients with frequent past problems were considered
suitable, providing that they reacted well to treatment.
In 4 of the questions though (The exact wording can be
seen in Additional file 1: Appendix 1: page 2 scenario 3,
page 3 scenario 1 and 3, and page 4 scenario 2), the
information provided was not sufficiently succinct for a
clear cut decision, and therefore"mainstream”answers
were based on the remaining 8 questions.
Quality of data
For validation purposes we obtained information on all
the members of the Danish Chiropractors’Association
on sex, age, college of graduation, and graduation year.
We compared this to the profile of our participants to
establish if our study sample was representative of its
target population.
The repeatability of the questionnaire was tested for
two of the clinical questions by asking them twice but
in different parts of the questionnaire: 1) the first sce-
nario on the second page and fourth page, and 2) the
first scenario on the third page and the third scenario
on the fourth page.
The self-reported use of MC was estimated by asking
for its proportional use both on the day of the study
and for the last working week. Both questions were
askedbecausethedataforthepresentdaywouldbe
easier collected (just counted) than data for the past
week. However, the week-data were there in case some
respondents on the day of the survey had an unusual
number of MC-patients.
Analysis and presentation of data
In the analyses, the variables age and clinical experience
were collapsed into fewer categories, based on the distri-
bution of data.
The distributions of MC use per day and per week
were analyzed with the help of frequency tables and
graphs and the mean value with standard deviations of
the weekly proportion of MC-patients were reported.
The number of"expected”answers for each participant
was calculated based on the 8 predetermined"expected”
answers. On the basis of the distribution of data this
variable was dichotomized into two groups, consisting
of"mainstream”(giving the"expected”answer for at least
7 of these 8 scenarios) vs."non-mainstream”answers (all
the others).
Associations between the demographic variables and
the proportional use of MC and the proportion of"main-
stream”answers were tested with bivariate analyses, and
thereafter with multivariate linear regression analyses
for the variables found to be significant in the bivariate
analyses. Because of the possibility of strong correlations
between several of the demographic variables, we tested
these correlations using Pearson’s r. The relationship
between the proportional use and the proportion
of"mainstream”answers was tested using kappa statis-
tics. Data were analysed with STATA 8.2 (STATA Cor-
poration, 2000, Stata Statistical Software Release 8.2,
College Station, Tex., USA) and a p-level of 0.05 or less
was considered statistically significant.
Results
Description of the participants and their use of
maintenance care
In all, 296 out of 413 active members of the Danish
Chiropractors’Association (72%) returned their ques-
tionnaires, with an even distribution of men and
women. Two-thirds of the participants were aged 30-49
years and almost half had graduated in the USA or
Canada. The details are presented in Table 1 and a simi-
lar description of the members of the Danish Chiroprac-
tors’Association is presented in the same table for
comparison.
The mean and median values of the self-reported pro-
portion of MC patients were almost identical for the last
full working week and the day of the survey. The
reported proportion of MC-patients the past week ranged
from 0% to 100%, with 15 missing replies and the mean
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value of MC patients per week was 22% (SD19). Based on
the distribution, three subgroups were determined. The
first group consisted of chiropractors who defined 0%
-25% of the patients seen that week as MC patients (n =
195). The second group reported that 26% -42% of their
patients were MC patients (n = 46), and the third group
reported their proportion of MC patients to be 43%-
100% (n = 40). For ease of reporting, these groups were
called"low”,"medium”, and"high”, respectively.
Validity of data
The study sample closely resembled the target popula-
tion, i.e. all the members of the Danish Chiropractors’
Association as seen in Table 1.
The internal consistency was good for one pair of
identical questions (an acute patient with no previous
history of LBP and good response to treatment: page 1,
scenario 1 and page 3, scenario1) with agreement in
94% of the cases. However, the second pair of identical
questions (a patient with recurrent LBP, one episode per
month for five years and good response to treatment:
page 2, scenario 1 and page 3, scenario 3) was less con-
vincing with 54% total agreement.
Indications for use of maintenance care
In relation to the indications for the use of MC, 40%
(n = 118) of the participants were classified as"main-
stream”practitioners, giving the expected answer in at
Table 1 A comparison of the study sample in a survey of Danish chiropractors and the target population (%)
Compared variables Danish Chiropractors’Association
(N = 455, of which 413 are active members)
Study sample
(N = 296)
Gender
females 51 46
Males 49 45
missing 9
Age
20-29 6 4
30-39 31 35
40-49 38 38
50-59 18 20
60 or more 7 4
missing <1
Graduated in
Denmark 33 30
UK 22 24
USA/Canada 45 46
other < 1 0
missing <1
Clinical experience (yrs)
0-1 71
2-5 18 22
6-10 10 9
11-19 25 29
20 or more 38 39
missing 2 < 1
Where do you work (several answers possible)
general practice (data not available) 93
Falck health Care/Private hospital 16
Public hospital 4
Other 4
Are you (several answers possible)
clinic owner 62 65
employee 38 31
both (data not available) 3
missing 1
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least 7 of the 8 cases. For each of the 8 individual cases,
57% to 89% of the participants responded as expected.
1. Maintenance care in patients with no previous history of
back problems but with different outcomes
Overall, the results of the first set of cases were in
accordance with the expectations of the research group,
as the majority of respondents found it unsuitable to
provide MC to patients with no previous history of LBP
at all. There was only one possible exception. In sce-
nario 3, depicting a patient who does not improve over
two months of treatment ("some days are good, some
are bad”), 54% of the chiropractors responded either"-
perhaps”or"yes”to the consideration of MC. For this
scenario, the research team expected the majority to
reply"no”(Table 2).
2. Maintenance care in patients with monthly episodes of
LBP but with different outcomes
Information collected in this part of the questionnaire
did not always agree with the expectations of the
research group (Table 3). In the first two scenarios, in
which the patient is getting better in relation to the
treatment, the"expected”answer would be to consider
MC. However, in the patient who improves directly on
the first visit and whose pain does not recur within two
months, only 41% would offer MC, whereas 58% would
offer MC to the other person who had a recurrence
after one month. If the patient does not improve after
two months ("some days are good some are bad”), 54%
of the chiropractors answer"yes”or"perhaps”to offering
MC. In this case the research team had expected a
response of"no”. For the patient who gradually gets
worse, the research team had also anticipated a majority
response of"no”and 88% of the respondents agreed with
that concept.
3. Maintenance care in patients with good outcome but
different past histories
As expected, 87% would not offer MC to a patient with
immediate and lasting positive response and no previous
history of back pain. The opinions were mixed if there
had been 1-2 episodes of LBP a year, with 46% answer-
ing"perhaps”, whereas the research team’sexpected
answer was"yes”. The majority, however, agreed that
MC would be suitable for more frequent past episodes.
For monthly episodes, 70% were in favour, and 69% for
weekly episodes. This was in line with the"expected”
answers (Table 4).
Associations between the demographic background and
the proportional use of maintenance care
There were no statistically differences in the use of MC
between men and women or between age groups. How-
ever, there were statistically significant differences
between the proportion of MC-patients per week and
the other factors investigated: 1) graduates from USA/
Canada had the highest use of MC and graduates from
Denmark the lowest, 2) more years in practice was asso-
ciated with a higher use of MC, and 3) clinic owners
used MC more often than employees, see Tables 5, 6, 7.
However, these three factors are closely interrelated.
Almost all chiropractors in Denmark with less than 11
years of experience are graduates from Denmark.
Because of the strong correlation between graduation
Table 2 The use of maintenance care in patients with no previous history of low back pain and different outcomes of
treatment
“Would you consider recommending MC to
this patient?”
No Perhaps Yes Missing
Follow-up scenarios Frequency
(%)
Frequency
(%)
Frequency
(%)
Frequency
(%)
You treat him once and the symptoms disappear directly after you manipulated the painful area.
You follow for him two months and the pain does not reappear, the movement pattern is
normal, and you cannot provoke any symptoms by palpation or other tests.
264
(89%)
16
(5%)
12
(4%)
4
(1%)
You treat him once and the symptoms disappear directly after you manipulated the painful area.
You follow him for two months and after one month there is a recurrence. But after one more
treatment the pain does not reappear, the movement pattern is normal, and you cannot
provoke any symptoms by palpation or other tests.
169
(57%)
82
(28%)
39
(13%)
6
(2%)
You treat him for two months and you can see from his file that some days are good some are
bad, but in all there is no difference really.
132
(45%)
92
(31%)
67
(23%)
5
(2%)
You treat him for 2 months and he is getting gradually worse. 260
(88%)
18
(6%)
13
(4%)
5
(2%)
The following basic case was given:"A 40-year old man consults you for low back pain of 2 days duration with no additional spinal or musculoskeletal problems,
and with no other health problems. His x-rays are normal for his age. There are no red flags and he seems to in good shape both psychically and
psychologically. There are no aggravating factors at work or at home.”The expected answers are written in bold, and where the majority of the practitioners
agree with the research team, the answer is also in italics.
The use of maintenance care based on patients with a history of one episode of LBP per month the last 5 years lasting 5-6 days resolving spontaneously and
different outcomes.
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and experience (Pearson’s r = 0.82, p < 0.001), gradua-
tion and employment (Pearson’s r = -0.54, p < 0.001),
and between experience and employment (Pearson’sr=
-0.57, p < 0.001) we did not perform a multi-variate
analysis. It is therefore not possible to determine
whether high use of MC is determined by educational
background or experience.
Associations between the demographic background,
care and"mainstream”use of MC
Neither the demographic data nor the use of MC was
associated with the"mainstream”answers in the analyses.
Discussion
Theresultsofthisstudyindicatethatourstudysample
was representative of the membership of the Danish
Chiropractors’Association. Among Danish chiropractors
there is a wide variation in the use of MC; some not
usingitatallandothersalways.Astrongdeterminant
for this was, not surprisingly, their educational back-
ground, with the American-educated chiropractors being
more likely to have more MC patients than those edu-
cated in the UK or Denmark. It is possible that the use of
MC is a major differential factor between European-style
and American-style chiropractic. One should therefore
be careful when interpreting data on this topic from dif-
ferent parts of the world. However, since there is a strong
correlation between country of graduation and years of
clinical experience among Danish chiropractors, this dif-
ference could also be related to experience.
Whether MC is a useful approach or not, is not
known, but assuming that it does have an effect, it
Table 3 The use of maintenance care based on patients with a history of one episode of LBP per month the last 5
years lasting 5-6 days resolving spontaneously and different outcomes
“Would you consider recommending MC to
this patient?”
No Perhaps Yes Missing
Follow-up scenarios Frequency
(%)
Frequency
(%)
Frequency
(%)
Frequency
(%)
You treat him once and the symptoms disappear directly after you manipulated the painful area.
You follow him for two months and the pain does not reappear, the movement pattern is
normal, and you cannot provoke any symptoms by palpation or other tests.
83
(28%)
88
(30%)
120
(41%)
5
(2%)
You treat him once and the symptoms disappear directly after you manipulated the painful area.
You follow him for two months and after one month there is a recurrence. But after one more
treatment the pain does not reappear, the movement pattern is normal, and you cannot
provoke any symptoms by palpation or other tests.
27
(9%)
94
(32%)
171
(58%)
4
(1%)
You treat him for two months and you can see from his file that some days are good some are
bad, but in all there is no difference really.
129
(44%)
90
(30%)
71
(24%)
6
(2%)
You treat him for 2 months and he is gradually getting worse. 259
(88%)
21
(7%)
10
(3%)
6
(2%)
The following basic case was given:"A 40-year old man consults you for low back pain of 2 days duration with no additional spinal or musculoskeletal problems,
and with no other health problems. His x-rays are normal for his age. There are no red flags and he seems to in good shape both psychically and
psychologically. There are no aggravating factors at work or at home.”The expected answers are written in bold, and where the majority of the practitioners
agree with the research team, the answer is also in italics.
Table 4 The use of maintenance care in patients with different past histories but identical outcomes
“Would you consider recommending MC to
this patient?”
No Perhaps Yes Missing
Past history Frequency
(%)
Frequency
(%)
Frequency
(%)
Frequency
(%)
He has never previously had any back pain at all. 257
(87%)
19
(6%)
12
(4%)
8
(3%)
Over the past 5 years he has had 1-2 episodes of LBP a year, each event lasting 5-6 days and
resolving spontaneously.
67
(23%)
135
(46%)
86
(29%)
8
(3%)
Over the past 5 years he has had 1 episode of LBP per month, each event lasting 5-6 days
and resolving spontaneously.
20
(7%)
61
(21%)
207
(70%)
8
(3%)
Over the past 5 years he had about 1 episode per week, each event lasting 2-3 days and
resolving spontaneously.
29
(10%)
54
(18%)
205
(69%)
8
(3%)
The following course of treatment was given: You treat him once and the symptoms disappear directly after a manipulation to the painful area. You followhim
for two months and the pain does not reappear, the movement pattern is normal and you cannot provoke any symptoms by palpation or other tests. The
expected answers are written in bold, and where the majority of the practitioners agree with the research team, the answer is also in italics.
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should be used in such a way as to be cost-effective for
the patient. Therefore it seemed logical that good out-
come should be a major prerequisite, as should a con-
siderable risk of future LBP. This was also the result in
this study as well as in previous studies.
Interestingly, respondents who provided the unex-
pected answers could do this in both directions, i.e. not
offering MC to a case with a profile assumed to be sui-
table or offering MC to those assumed to be unsuitable.
This shows there is some diversity in the chiropractic
profession regarding MC. If such a thing as"correct”
answers exists to these survey questions, some chiro-
practors will offer MC more frequently and others less
frequently. On that note, it must be remembered that
the clinical scenarios presented in the survey have very
limited information and many other factors (e.g. the
psychological profile of the patient, various types of
spinal problems, etiology of the back pain etc.) might
influence the chiropractor’schoice[11].Despitethese
shortcomingsofthesurvey,thereisalargedegreeof
consensus among the chiropractors.
There seems to be a general agreement that MC
should be used in patients at risk for future problems
and that the past history is a predictor of that. Further,
the patient should improve with treatment. As for the
cut-off point for past LBP events, it lies somewhere
between one episode per year and one per month, but
probably closer to the latter.
For clinicians, also the non-indications for MC treat-
ment are important. Almost 90% agreed that patients
who recovered very quickly, remained stable over two
months, and who had no past history of LBP should not
have MC. And about as many of our participants would
not consider MC for patients who got gradually worse.
Curiously, there was no majority"no"- response for the
patients who"oscillated”(some days good some days
bad) with no real improvement. Also according to pre-
vious Swedish and Danish studies, subgroups of respon-
dents who would recommend MC also in patients who
do not report a clinically relevant amount of improve-
ment were noted [7,10,11]. Further, in a Finnish study,
some argued that lack of treatment success could also
be an indication for MC [12]. We had hoped for some
clear indications on this issue, but some confusion
remains. Perhaps such answers arise because some chir-
opractors consider chiropractic treatment always to be
of benefit, regardless the reporting of symptoms. This
was neither the opinion of the research team, nor of the
majority of respondents, but until the value of MC has
been tested in a number of randomized controlled clini-
cal trials, nobody can tell who is right.
Conclusions
We were able to reach four distinct conclusions:
•About 2/3 of the Danish chiropractors reported to
use MC on between 0 and 25% of their patients.
•The most frequent use of MC was reported by
chiropractors who were graduates from North
America, experienced chiropractors and clinic
owners.
•For Danish chiropractors in general, the indica-
tions for MC in patients with LBP were: good short-
term outcome and at least 1-2 previous episodes per
year.
•There were no associations between the demo-
graphic background and the indications for the use
of MC.
Conflict of interests
The authors declare that they have no competing
interests.
Table 5 The weekly use of MC among Danish
chiropractors in relation to clinical experience.
Use of MC per week
Clinical experience (years) Low Medium High Total
0-1 3 (100) 0 0 3 (100)
2-5 54 (86) 5 (8) 4 (6) 63 (100)
6-10 19 (73) 4 (15) 3 (12) 26 (100)
11-19 49 (58) 23 (27) 12 (14) 84 (100)
20 or more 69 (66) 14 (13) 21 (20) 104 (100)
Total 194 (69) 46 (16) 40 (14) 280 (100)
Test for linear trend, p < 0.005
Table 6 The weekly use of MC among Danish
chiropractors in relation to country of graduation.
Use of MC per week
Graduated in Low Medium High Total
Denmark 73 (84) 8 (9) 6 (7) 87 (100)
UK 46 (71) 14 (22) 5 (8) 65 (100)
USA/Canada 76 (59) 24 (19) 29 (22) 129 (100)
Total 195 (69) 46 (16) 40 (14) 281 (100)
Pearson chi2(4) = 20.2974 Pr = 0.000
Table 7 The weekly use of MC among Danish
chiropractors in relation to employment.
Use of MC per week
Employement Low Medium High Total
Clinic owner 116 (63) 34 (19) 33 (18) 183 (100)
Employee 72 (81) 10 (11) 7 (8) 89 (100)
Both 6 (75) 2 (25) 0 8 (100)
Total 194 (69) 46 (16) 40 (14) 280 (100)
Pearson chi2(4) = 10.5322 Pr = 0.032
Hansen et al.Chiropractic & Osteopathy 2010, 18:25
http://www.chiroandosteo.com/content/18/1/25
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Additional material
Additional file 1: Questionnaire. A copy of the questionnaire used in
the survey about the use of maintenance care in Danish chiropractic
practice.
Author details
1
Institute of Clinical Biomechanics, University of Southern Denmark, Odense,
Denmark.
2
The Back Research Center, Ringe, University of Southern Denmark,
Odense, Denmark.
3
Nordic Institute for Chiropractic and Clinical
Biomechanics, University of Southern Denmark, Odense, Denmark.
Authors’contributions
SHF and ALSH designed the study, collected and analyzed the preliminary
data and wrote a report on part of the results as a part requirement for
their masters degree in Health Sciences (Biomechanics), supervised by CLY
and LH. TSJ supervised and assisted with the data analysis. CLY and LH were
responsible for the final manuscript. All authors read and approved the final
manuscript.
Received: 30 September 2009 Accepted: 1 September 2010
Published: 1 September 2010
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doi:10.1186/1746-1340-18-25
Cite this article as: Hansen et al.: The Nordic maintenance care
program: what are the indications for maintenance care in patients
with low back pain? A survey of the members of the Danish
Chiropractors’Association. Chiropractic & Osteopathy 2010 18:25.
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