Dataset Information

The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors.

ABSTRACT:

Objective

To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.

Methods

Semi-structured interviews were conducted with 10 chiropractors identified using a stratified, theoretical sampling framework. Interviews covered four domains relating to MC, namely: purpose, patient characteristics, content, and course and development. Data was analysed thematically.

Results

Practitioners regard MC primarily as a means of providing secondary or tertiary care and they primarily recommend it to patients with a history of recurrence. Initiating MC is often a shared decision between clinician and patient. The core elements of MC are examination and manipulation, but exercise and general lifestyle advice are often included. Typically, treatment intervals lie between 2 and 4 months. Clinician MC practices seem to evolve over time and are informed by individual practice experiences.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.

Conclusion

MC is perceived as both a secondary and tertiary preventative measure and its practice appears grounded in the tenet of patient-oriented care. A positive personal relationship between chiropractor and patient facilitates the initiation of MC. The results from this and previous studies should be considered in the design of studies of efficacy.

SUBMITTER: Myburgh C

PROVIDER: S-EPMC3766236 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Publications

The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors.

Myburgh Corrie C Brandborg-Olsen Dorthe D Albert Hanne H Hestbaek Lise L

Chiropractic & manual therapies 20130820 1

<h4>Objective</h4>To describe and interpret Danish Chiropractors' perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.<h4>Methods</h4>Semi-structured interviews were conducted with 10 chiropractors identified using a stratified, theoretical sampling framework. Interviews covered four domains relating to MC, namely: purpose, patient characteristics, content, and course and development. Data was analysed thematically.<h4 ...[more]

PMID: 23962318

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Project description:BackgroundAlthough maintenance care appears to be relatively commonly used among chiropractors, the indications for its use are incompletely understood. A questionnaire survey was recently carried out among Swedish chiropractors in order to identify their choice of various management strategies, including maintenance care. That study revealed a common pattern of choice of strategies. However, it would be necessary to verify these findings in another study population and to obtain some additional information best collected through an interview.ObjectivesThe main aim of the present study was to attempt to reproduce the findings in the Swedish study and to obtain more information on the use of maintenance care.MethodA group of 11 chiropractors were selected because they used maintenance care. They were interviewed using the questionnaire from the previous Swedish survey. The questionnaire consisted of a simple description of a hypothetical patient with low back pain and nine possible ways in which the case could develop ("scenarios"). They could choose between six different management strategies for each scenario. In addition, the chiropractors were encouraged to provide their own definition of maintenance care in an open-ended question. Interviews were taped, transcribed and analyzed. For the open-ended question, statements were identified relating to six pre hoc defined topics on the inclusion criteria/rationale for maintenance care, the frequency of treatments, and the duration of the maintenance care program.ResultsThe open-ended question revealed that in patients with low back pain, maintenance care appears to be offered to prevent new events. The rationale was to obtain optimal spinal function. There appears to be no common convention on the frequency of treatments and duration of the treatment program was not mentioned by any of the interviewees.ConclusionThe 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. However, more precise information is needed on the indications for maintenance care and its treatment program, before proceeding to studying its clinical validity.

Project description: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.

Project description:BackgroundChiropractic treatment for low back pain (LBP) can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care.MethodThe design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team.ResultsReplies were received from 59 (60%) of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. 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. However, also other management patterns were noted, in particular in the direction of maintenance care.ConclusionTo a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of LBP.

Project description:BackgroundAmong chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP).MethodStructured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA) were invited to participate in the discussions and in the questionnaire survey.ResultsThirty-six (22%) of SCA members participated in the group discussions and 129 (77%) returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50-69% of the respondents, namely duration (over the past year and of the present attack), treatment (effect and durability), lifestyle, work conditions, and psychosocial factors (including attitude).ConclusionThe vast majority of our respondents believe that chiropractic treatment can prevent relapses of back pain. When recommending secondary preventive care, past frequency of the problem is considered. For tertiary preventive care, the patient needs to improve considerably before a recommendation of maintenance care is made.

Project description:BackgroundIn Denmark, chiropractors in primary care work as independent private contractors regulated by the Danish National Health Authorities. The regulation includes partial reimbursement intended for standardised care packages for lumbar and cervical radiculopathy and lumbar spinal stenosis. Random checks have shown lower use than expected. This study aimed to describe and explore the utilisation of standardised chiropractic care packages and identify barriers to uptake.MethodsA convergent mixed-method design was conceptualised. The use of standardised care packages was collected by register data. Potential determinants of difference in utilisation were assessed using a modified version of the Determinants of Implementation Behaviour Questionnaire (DIBQ) divided into 13 domains and sent to chiropractors in private clinics in Denmark in 2019. An open-ended question was added to the questionnaire, and thematic content analysis was applied. Qualitative findings were used to expand on the DIBQ data providing further insight into the clinicians' perspective on standardised care packages. RESULTS: Registry data of 244 included chiropractic clinics showed limited and inconsistent use of the standardised chiropractic care packages. A total of 269 chiropractors (44%) answered the DIBQ, and 45 provided data for the qualitative analyses. At least 60% of the clinicians answered 'Strongly agree' or 'Agree' in 10 out of 13 DIBQ domains suggesting a positive attitude towards using the standardised care packages. Three domains were identified as 'problematic' as more than 20% of clinicians disagreed or strongly disagreed: 'Socio-political context', 'Goals' and 'Innovation'. Qualitative findings indicated that lack of usage of the standardised care packages was mainly related to the practical organization of standardised care, the chiropractor's role when managing patients, and the patient population of interest to the clinic (e.g., children, athletes).ConclusionIn general, Danish chiropractors displayed positive attitudes towards standardised packages of care. However, considerable variation in the use of the standardised care programs was observed. Low utilisation seemed mainly related to logistics, the chiropractor's role, collaboration with GPs, and the patient population of interest to the clinic. These findings should be further explored in more extensive qualitative studies to inform implementation initiatives to increase and rectify utility.

Project description:BackgroundChiropractic maintenance care (MC) has been found to be effective for patients classified as dysfunctional by the West Haven-Yale Multidimensional Pain Inventory (MPI). Although displaying good psychometric properties, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. The aim was to develop a brief clinical instrument with the intent of identifying dysfunctional patients with acceptable diagnostic accuracy.MethodsData from 249 patients with a complete MPI dataset from a randomized clinical trial that investigated the effect and cost-effectiveness of MC with a 12-month follow-up was used in this cross-sectional analysis. A brief screening instrument was developed to identify dysfunctional patients, with a summary measure. Different cut-offs were considered with regards to diagnostic accuracy using the original instrument's classification of dysfunctional patients as a reference. Very good diagnostic accuracy was defined as an area under the curve (AUC) metric between 0.8 and 0.9. The instrument was then externally validated in 3 other existing datasets to assess model transportability across populations and medical settings.ResultsUsing an explorative approach, the MAINTAIN instrument with 10 questions (0-6 Likert responses) capturing 5 dimensions (pain severity, interference, life control, affective distress, and support) was developed, generating an algorithm-based score ranging from - 12 to 48. Reporting a MAINTAIN score of 18 or higher, 146 out of the 249 patients were classified as dysfunctional with 95.8% sensitivity and 64.3% specificity. At a score of 22 or higher, 109/249 were classified as dysfunctional with 81.1% sensitivity and 79.2% specificity. AUC was estimated to 0.87 (95% CI 0.83, 0.92) and Youden's index was highest (0.70) at a score of 20. The diagnostic accuracy was similar and high across populations with minor differences in optimal thresholds for identifying dysfunctional individuals.ConclusionThe MAINTAIN instrument has very good diagnostic accuracy with regards to identifying dysfunctional patients and may be used as a decision aid in clinical practice. By using 2 thresholds, patients can be categorized into "low probability (- 12 to 17)", "moderate probability (18 to 21)", and "high probability (22 to 48)" of having a good outcome from maintenance care for low back pain.Trial registrationClinical trials.gov; NCT01539863; registered February 28, 2012; https://clinicaltrials.gov/ct2/show/NCT01539863 .

Project description:BackgroundThe Finnish chiropractic profession is young and not fully accepted by Finnish healthcare authorities. The demographic profile and style of practice has not been described to date. However, as the profession seems to be under rapid development, it would be of interest to stakeholders, both chiropractic and political, to obtain a baseline description of this profession with a view to the development of future goals and strategies for the profession. The purpose of this study was to describe the chiropractic profession in Finland in relation to its demographic background, the demographics of their clinics, practice patterns, interactions with other health care practitioners and some of the professions' plans for the future.MethodsA structured questionnaire survey was conducted in 2005, in which all 50 members of the Finnish Chiropractic Union were invited to participate.ResultsIn all, 44 questionnaires were returned (response rate 88%). Eighty percent of the respondents were men, and 77% were aged 30 to 44 years old, most of whom graduated after 1990 with either a university-based bachelors' or masters' degree in chiropractic. Solo practice was their main practice pattern. The vast majority described their scope of practice to be based on a musculoskeletal approach, using the Diversified Technique, performing Soft Tissue Therapy and about two-thirds also used an Activator Instrument (mechanical adjusting instrument). The mean number of patient visits reported to have been seen weekly was 59 of which nine were new patients. Most practitioners found this number of patients satisfactory. At the initial consultation, 80% of respondents spent 30-45 minutes with their patients, 75% spent 20-30 minutes with "new old" patients and on subsequent visits 80% of respondents spent 15-30 minutes. Interactions with other health care professions were reasonably good and most of chiropractors intended to remain within the profession.ConclusionThe Finnish chiropractic profession is relatively young. Consequently, many of the practitioners have a university-degree, which reflects recent developments in undergraduate chiropractic education. Their practice profile and the manner in which they practice appear to be fairly traditional.

Project description:BackgroundIn contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors.ObjectiveThis study examined older adults' perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people's opinions, shedding light on their preferences, concerns, and potential barriers to adoption.MethodsData were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ≥65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents' narratives.ResultsThe analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives.ConclusionsThe decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements.

Dataset Information

The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors.

Objective

Methods

Results

Conclusion

Publications

The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors.

Similar Datasets

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