The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Therapy: Ongoing Maintenance Care.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders. The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Therapy: Ongoing Maintenance Care

Following the diagnosis of MMI, a maintenance program of manual therapy, occupational therapy, or spinal manipulation (by a doctor (MD/DO), chiropractor, or physical therapist) may be recommended when linked to improvements in functional status.

Maintenance treatment techniques may be necessary for some circumstances, even if the evaluated body of scientific data does not support the usual use of this intervention.

Therapy: Ongoing Maintenance Care are recommended in a subset of patients to preserve functional status, in the absence of which an objective decline in function has already been seen and noted in the medical file.

Frequency: Following the assessment of MMI, the maximum number of visits per year is 10, provided that the preservation of functional status is objectively documented. There can be no deviation from the maximum frequency.

Rationale:

• To establish the necessity for continuing maintenance treatment, specific target goals should be set and monitored.

• To determine if therapeutic goals can be upheld in the truancy of clinical treatments, longer and longer therapeutic withdrawal studies will be tried.

• A trial without improvement therapy should start within one year and every year after that.

• An ongoing patient self-management program carried out by the patient regularly and a self-directed pain management program is started as required in the treatment of chronic neck symptoms:

  • To motivate physical activity and work activities notwithstanding persistent pain, to preserve function, an ongoing clinically suitable self-management plan should be put into place. This plan is typically independent, home-based, and self-directed, and it is developed cooperatively by the contributor and patient.

  • A self-directed ache management strategy should be created in augmentation to the self-management scheme so that the patient can start it if their symptoms get worse and their ability to function declines.

• Resuming continuous maintenance may be appropriate if a decline in the ability to sustain function is proven.

The New York Non-Acute Pain Medical Treatment Guidelines provide guidelines for Functional Maintenance Care, which include Ongoing Maintenance Care as one of their components.

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