Prior Banner

C-prior: Implementation of the MAINTAIN instrument for patients with spinal pain – a randomized clinical trial

Principal investigator:

Dr. Martha Funabashi –


Dr. Katie Pohlman, Sheilah Hogg-Johnson, Murray Townsend, Luciana Macedo, Andreas Eklund

Project Coordinator:

Neamat Mowafy -

What are we doing?

This study aims to better understand the impact of using the MAINTAIN instrument into clinical practice. This study will help understand who are the patients who most benefit from a Maintenance Care approach.

Why are we doing it?

Previous studies showed that patients with specific characteristics present less days with pain when treated with chiropractic maintenance care approach1, 2. Based on these results, a clinical instrument, the MAINTAIN instrument, was developed to identify those patients who would benefit from chiropractic maintenance care approach3.

However, the usability and impact of the MAINTAIN instrument applied in clinical practice remains unknown.

How are we doing it?

Participating chiropractors are asked to collect data from 15 consecutive patients with significant and recurrent spinal pain. This study will track patients’ number of activity-limiting pain for 12 months via text (SMS) messages.

All participating patients will receive initial chiropractic care for 3 weeks (6 visits). After this initial period, patients will be randomized to one of two intervention arms:

  1. Stratified care: Based on patients’ response to initial care and the MAINTAIN instrument, patients will be stratified to receive maintenance care or symptom-guided care plus a home-based exercise program.
  2. Standard care: Patients will receive a pragmatic chiropractic care in which treatment will be provided based on the clinician’s judgement plus a home-based exercise program.

Both patients and chiropractors will complete questionnaires at 3 weeks, 3, 6, and 12 months.


If you have any questions or want additional information, please contact the study coordinator (Neamat Mowafy) at or the principal investigator (

  1. Eklund A, Hagberg J, Jensen I, Leboeuf-Yde C, Kongsted A, Lovgren P, et al. 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. 2020;28(1):19.
  2. Eklund A, Jensen I, Leboeuf-Yde C, Kongsted A, Jonsson M, Lovgren P, et al. 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. PLoS One. 2019;14(10):e0223349.
  3. Eklund A, Palmgren PJ, Jakobsson U, Axen I. 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. 2022;30(1):15.

If you are interested in participating, please complete this Interest Form