MAINTAIN is an intake screening questionnaire that flags which spinal pain patients may benefit from maintenance care. In a 2026 study at two US teaching clinics, 39.6% of patients screened as candidates. It sorts patients into the right plan. It does not tell a patient whether the plan is working.
What does the MAINTAIN instrument actually measure?
It scores pain history and the psychological and behavioral factors around it, not exam findings. The instrument was built to characterize patients with recurrent or persistent spine pain and to identify who fits the maintenance care pattern described in the Nordic maintenance care literature.
It is completed by the patient at intake. It is not a repeated measure and not a physical test. Think of it as triage for how long a course of care should run.
What did the 2026 study find?
About four in ten patients screened as maintenance care candidates. A cross-sectional study published in 2026 screened 597 spinal pain patients at two US chiropractic teaching clinics. Of the 91 patients with valid completed data, 39.6% screened as potential maintenance care candidates. The mean score was 15.06 with a standard deviation of 9.03.
The qualitative half of that study is the more useful part for a practice owner. Clinicians reported using the scores to guide follow-up frequency, to set recovery expectations, and to separate patients likely to need a longer horizon from patients who could be managed symptom to symptom.
Does using it improve patient retention?
Nobody has shown that yet, and the study did not claim it. It was a pilot with 91 completed questionnaires, no retention endpoint, and no control group. A randomized trial comparing stratified maintenance care against standard chiropractic care is underway, with days of activity-limiting pain over 12 months as the primary outcome.
The plausible mechanism is indirect. Better-matched expectations at visit one may reduce the mismatch that shows up as dropout at visit four. That is a reasonable hypothesis. It is not yet a result.
| Tool | When it is used | What question it answers | Repeated over time? |
|---|---|---|---|
| MAINTAIN instrument | Intake | Who may need longer-horizon care? | No |
| Oswestry or Neck Disability Index | Intake and re-exam | How limited is this patient right now? | Yes |
| Range of motion testing | Every re-exam | Has movement changed? | Yes |
| Soft tissue stiffness measurement | Baseline and re-exam | Has tissue state changed independent of pain? | Yes |
Where does a screening tool stop helping?
At the moment the patient starts deciding whether to come back. A screening score explains why you recommended twelve visits. It says nothing about visit seven, when the patient feels roughly the same and is quietly wondering whether this is working.
That is the gap the dropout data sits in. Patients do not leave because the plan was poorly stratified. They leave because they cannot tell whether anything changed.
Survey data: In a 2026 survey of 455 patients who stopped chiropractic care, 58% cited perception-based reasons: 36% felt no progress, and 22% felt better and stopped. Neither group was told their stiffness was still elevated.
How should a practice use it?
Use it to set the plan, then use something repeatable to defend the plan. Screening at intake and objective findings at re-examination do different jobs. One decides the care horizon. The other gives the patient evidence that the horizon is earning its keep.
Run the arithmetic on why this matters. At an average chiropractic visit fee near $80 per the ChiroEco 28th Annual Survey, losing five patients a month to early dropout costs roughly $105,000 a year in potential revenue. A better intake stratification does not recover that on its own. Something the patient can see at visit seven has a better chance.
Frequently Asked Questions
What is the MAINTAIN instrument?
MAINTAIN is a questionnaire-based screening tool that identifies which patients with recurrent or persistent spinal pain may be candidates for chiropractic maintenance care. It scores pain history and related psychological and behavioral factors rather than imaging or exam findings.
How many patients screen as maintenance care candidates?
In a 2026 cross-sectional study at two US chiropractic teaching clinics, 39.6% of the 91 patients who completed the instrument screened as potential maintenance care candidates. Mean score was 15.06 with a standard deviation of 9.03.
Does the MAINTAIN instrument improve retention?
That has not been demonstrated yet. The 2026 study reported that clinicians used the scores to shape visit frequency and recovery expectations. A randomized trial is underway to test whether stratified maintenance care outperforms standard chiropractic care.
Is MAINTAIN an objective outcome measure?
No. It is a patient-reported screening instrument used at intake, not a repeated outcome measure. It tells you who may need longer-horizon care, not whether the care is working.
How is MAINTAIN different from the Oswestry or Neck Disability Index?
Disability indexes quantify current functional limitation and are repeated to track change. MAINTAIN sorts patients by their likely care trajectory. The two answer different questions and can be used together.
Can a screening score be shown to the patient?
It can, but it is a poor persuasion tool. A score that says you may need long-term care sounds like a sales argument unless it sits next to measurements that change visit to visit.
What should a practice pair a screening instrument with?
Pair it with something measured that moves. Screening sets the plan, and repeated objective findings give the patient a reason to believe the plan is working.
One approach is to add a second channel of objective data alongside subjective pain reports. Options include soft tissue stiffness measurement (such as MuscleMap), range-of-motion testing, and posture analysis. Each gives you something concrete to show the patient rather than asking them to take your word for it.