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
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 respo...
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| description | 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. |
| doi_str_mv | 10.1371/journal.pone.0223349 |
| format | Article |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0223349</identifier><identifier>PMID: 31600269</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adaptive control ; Adult ; Analysis ; Back pain ; Biology and Life Sciences ; Biomechanics ; Care and treatment ; Case-Control Studies ; Chiropractic medicine ; Clinical trials ; Environmental health ; Female ; Humans ; Intervention ; Low back pain ; Low Back Pain - psychology ; Low Back Pain - therapy ; Maintenance ; Male ; Manipulative therapy ; Medical prognosis ; Medical research ; Medicine and Health Sciences ; Middle Aged ; Musculoskeletal Manipulations - psychology ; Pain ; Pain management ; Patients ; People and places ; Randomization ; Randomized Controlled Trials as Topic ; Regression analysis ; Science Policy ; Secondary analysis ; Social Sciences ; Studies ; Subgroups ; Treatment Outcome</subject><ispartof>PloS one, 2019-10, Vol.14 (10), p.e0223349</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Eklund et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Eklund et al 2019 Eklund et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c730t-b47b763a033c7a94541a988de1e63589cbdb40ade4dedab0ca18116821132ecd3</citedby><cites>FETCH-LOGICAL-c730t-b47b763a033c7a94541a988de1e63589cbdb40ade4dedab0ca18116821132ecd3</cites><orcidid>0000-0002-2162-7537</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786625/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786625/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31600269$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:143669119$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Eklund, Andreas</creatorcontrib><creatorcontrib>Jensen, Irene</creatorcontrib><creatorcontrib>Leboeuf-Yde, Charlotte</creatorcontrib><creatorcontrib>Kongsted, Alice</creatorcontrib><creatorcontrib>Jonsson, Mattias</creatorcontrib><creatorcontrib>Lövgren, Peter</creatorcontrib><creatorcontrib>Petersen-Klingberg, Jakob</creatorcontrib><creatorcontrib>Calvert, Christian</creatorcontrib><creatorcontrib>Axén, Iben</creatorcontrib><title>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</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.</description><subject>Adaptive control</subject><subject>Adult</subject><subject>Analysis</subject><subject>Back pain</subject><subject>Biology and Life Sciences</subject><subject>Biomechanics</subject><subject>Care and treatment</subject><subject>Case-Control Studies</subject><subject>Chiropractic medicine</subject><subject>Clinical trials</subject><subject>Environmental health</subject><subject>Female</subject><subject>Humans</subject><subject>Intervention</subject><subject>Low back pain</subject><subject>Low Back Pain - psychology</subject><subject>Low Back Pain - therapy</subject><subject>Maintenance</subject><subject>Male</subject><subject>Manipulative therapy</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Musculoskeletal Manipulations - psychology</subject><subject>Pain</subject><subject>Pain management</subject><subject>Patients</subject><subject>People and places</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Regression analysis</subject><subject>Science Policy</subject><subject>Secondary analysis</subject><subject>Social Sciences</subject><subject>Studies</subject><subject>Subgroups</subject><subject>Treatment Outcome</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>D8T</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tu1DAQhiMEolB4AwSWkJC42MWOs3bCBagqp0qFIijcWhN7knVJ4mBnC8sT8lg43bRqJJBQLmKNv_k9xyR5wOiSccmenbmN76BZ9q7DJU1TzrPiRnKHFTxdiJTym9fOe8ndEM4oXfFciNvJHmeC0lQUd5Lfp2skH5w3VpP3YLsBO-g0kkPwSD56V3ton5NXDgPpw1avXeNqq6EhvXeVbZC0zthqS4YoM3iEocVuIFhVqAfiKgIRxPNos-eRhW4TXSProd-S8TV_cee6l-SABNSuM-C3BGJi22DDpQLULQwxQg-dca39hYZEdPCuaeJx8Baae8mtCpqA96f_fvLlzevTw3eL45O3R4cHxwstOR0WZSZLKThQzrWEIltlDIo8N8hQ8FVe6NKUGQWDmUEDJdXAcsZEnjLGU9SG7yePdrp944KamhBUyikvZF5QGomjHWEcnKne2zampBxYdWFwvlbgYzYNKlHI1FBDIS9ZJqkApCbNSi6LFAUVGLUWO63wA_tNOVObTN_iCVUmRSZl5F9M0W3KFo2OxfXQzNzmN51dq9qdKyHjZKSrKPB4EvDu-wbD8I8UJ6qGmIXtKhfFdGuDVgeCppwxKcZgln-h4mewtbF_OA7Q3OHpzGHsMf4catiEoI4-f_p_9uTrnH1yjV0jNMM6uGYzDl6Yg9kO1N6F4LG6qhyjaty6y2qocevUtHXR7eH1ql85Xa4Z_wOhTizg</recordid><startdate>20191010</startdate><enddate>20191010</enddate><creator>Eklund, Andreas</creator><creator>Jensen, Irene</creator><creator>Leboeuf-Yde, Charlotte</creator><creator>Kongsted, Alice</creator><creator>Jonsson, Mattias</creator><creator>Lövgren, Peter</creator><creator>Petersen-Klingberg, Jakob</creator><creator>Calvert, Christian</creator><creator>Axén, Iben</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2162-7537</orcidid></search><sort><creationdate>20191010</creationdate><title>The Nordic Maintenance Care Program: Does psychological profile modify the treatment effect of a preventive manual therapy intervention? 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A secondary analysis of a pragmatic randomized controlled trial</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-10-10</date><risdate>2019</risdate><volume>14</volume><issue>10</issue><spage>e0223349</spage><pages>e0223349-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31600269</pmid><doi>10.1371/journal.pone.0223349</doi><tpages>e0223349</tpages><orcidid>https://orcid.org/0000-0002-2162-7537</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
| recordid | cdi_plos_journals_2303978900 |
| source | Public Library of Science (PLoS) Journals Open Access; PubMed (Medline); MEDLINE; Directory of Open Access Journals; SWEPUB Freely available online; Free Full-Text Journals in Chemistry; EZB Electronic Journals Library |
| subjects | Adaptive control Adult Analysis Back pain Biology and Life Sciences Biomechanics Care and treatment Case-Control Studies Chiropractic medicine Clinical trials Environmental health Female Humans Intervention Low back pain Low Back Pain - psychology Low Back Pain - therapy Maintenance Male Manipulative therapy Medical prognosis Medical research Medicine and Health Sciences Middle Aged Musculoskeletal Manipulations - psychology Pain Pain management Patients People and places Randomization Randomized Controlled Trials as Topic Regression analysis Science Policy Secondary analysis Social Sciences Studies Subgroups Treatment Outcome |
| title | 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 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-11T17%3A08%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20Nordic%20Maintenance%20Care%20Program:%20Does%20psychological%20profile%20modify%20the%20treatment%20effect%20of%20a%20preventive%20manual%20therapy%20intervention?%20A%20secondary%20analysis%20of%20a%20pragmatic%20randomized%20controlled%20trial&rft.jtitle=PloS%20one&rft.au=Eklund,%20Andreas&rft.date=2019-10-10&rft.volume=14&rft.issue=10&rft.spage=e0223349&rft.pages=e0223349-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0223349&rft_dat=%3Cgale_plos_%3EA602311767%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2303978900&rft_id=info:pmid/31600269&rft_galeid=A602311767&rft_doaj_id=oai_doaj_org_article_6972d0d0a8b14706ae0d24b3792e606e&rfr_iscdi=true |