maintenance Care for Work-related lbP Study Title: Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence Authors: Cifuentes M, Willetts J & Wasiak R Publication Information : Journal of Occupational & Environmental Medicine 2011; 53(4): 396-404. baCKGround information It is well known that low back pain (LBP) is one of society’s costliest afflictions. Aside from lost work time and treatment costs associated with a new case of LBP, a potentially significant financial burden lies in the recurrence of this condition (which, as we know, is very common). In the occupational health field, sustained return-to-work is an important goal during in-jury recovery. Leaving work a second time after an initial episode is considered an appropri-ate indication of a recurrent condition, as this reflects the non-sustainability of working, and implies a failure of the return-to-work process. As chiropractors, we focus more on return-to-work than perhaps any other health care providers (such as physicians, who typically focus more on pain control). In the context of the current literature, demonstrating an association between specific type(s) of treatment or provider(s) and significant recurrence of a condition (measured as recurrent work disability) could imply an important advancement in the treatment of work-related back injuries. Signifi-cant financial savings hang in the balance. ‘Health maintenance care’ is a concept familiar to most chiropractors, conceptually aimed at reducing recurrence of a particular condition (in this case LBP) and/or enhancing general health. Such care can involve a range of interventions, from providing advice to offering physi-cal treatment or rehabilitation. Overall, very little research has been done on the effectiveness of this approach in general, and no studies have been done on its effectiveness for work-related LBP specifically. Therefore, the aim of this study was to compare occurrence of repeat-ed disability episodes across types of health care providers (chiropractors, physical therapists and physicians) who treat claimants with new episodes of work-related LBP. The authors hypothesized that since chiropractors generally are strong proponents of health maintenance care, their patients would experience a lower risk of recurrent disability. Shawn Thistle, BKin (Hons), DC, CSCS Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon-ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi-cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro-vider. For more information about the Research Review Service, visit www.researchreviewservice.com. ConCluSionS and PraCtiCal aPPliCationS In this study, an analysis was conducted of 894 patients suffering work-related LBP, from their first episode of disability through their subsequent return-to-work (health mainte-nance care period). Overall, about one tenth of the subjects experienced recurrent dis-ability due to LBP. After the authors controlled for demographics and severity indicators, the likelihood of recurrent disability due to LBP for recipients of services during the health maintenance care period by all other provider groups was consistently worse when compared with recipients of health maintenance care by chiropractors. Receiving chiropractic care during both disability (“curative”) and health maintenance care periods (main exposure variable, “preventive”), and the combination of both (curative and preventive) was associated with lower disability recurrence. This study is one of the first of its kind, offering supportive data from a work-related LBP perspective that our profession can utilize to support our continued inclusion in the care of occupational LBP. Further research is required to confirm and expand on these results, as well as extend our investigation of other common occupational injuries. • To view this review in full, including study methods, strengths and weaknesses; pertinent results; and additional references, please visit “Current Issue” at www.canadianchiropractor.ca. www.canadianchiropractor.ca 42 • CANADIAN CHIROPRACTOR | JUNE 2012
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