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Spine Article: Cost effectiveness
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Spine Article: Cost effectiveness - May 29, 2005 6:15:00 AM
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jma
Posts: 2319
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From: NY
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Interesting abstract. Thought to pass this along as well for your opinions on it.
"Cost-effectiveness of Combined Manipulation,
Stabilizing Exercises, and Physician Consultation
Compared to Physician Consultation Alone for Chronic
Low Back Pain: A Prospective Randomized Trial With
2-Year Follow-up
Leena Niemisto¨, MD,* Pekka Rissanen, PhD,† Seppo Sarna, PhD,‡
Tiina Lahtinen-Suopanki, PT,* Karl-August Lindgren, MD, PhD,* and Heikki Hurri, MD, PhD*
Study Design. A prospective, randomized controlled
trial.
Objective. To examine long-term effects and costs of
combined manipulative treatment, stabilizing exercises,
and physician consultation compared with physician consultation
alone for chronic low back pain (cLBP).
Summary of Background Data. An obvious gap exists
in knowledge concerning long-term efficacy and cost-effectiveness
of manipulative treatment methods.
Methods. Of 204 patients with cLBP whose Oswestry
Disability Index (ODI) was at least 16%, 102 were randomized
into a combined manipulative treatment, exercise,
and physician consultation group (i.e., a combination
group), and 102 to a consultation alone group. All patients
were clinically examined, informed about their back pain,
and encouraged to stay active and exercise according to
specific instructions based on clinical evaluation. Treatment
included 4 sessions of manual therapy and stabilizing
exercises aimed at correcting the lumbopelvic
rhythm. Questionnaires inquired about pain (visual analog
scale [VAS]), disability (ODI), health-related quality of
life (15D Quality of Life Instrument), satisfaction with care,
and costs.
Results. Significant improvement occurred in both
groups on every self-rated outcome measurement.
Within 2 years, the combination group showed only a
slightly more significant reduction in VAS (P 0.01, analysis
of variance) but clearly higher patient satisfaction
(P 0.001, Pearson 2) as compared to the consultation
group. Incremental analysis showed that for combined
group compared to consultation group, a one-point
change in VAS scale cost $512.
Conclusions. Physician consultation alone was more
cost-effective for both health care use and work absenteeism,
and led to equal improvement in disability and
health-related quality of life. It seems obvious that encouraging
information and advice are major elements for
the treatment of patients with cLBP.
Key words: low back pain, randomized controlled trial,
spinal manipulation, cost-effectiveness. Spine 2005;30:
1109–1115"
JMA
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Re: Spine Article: Cost effectiveness - June 8, 2005 8:56:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Makes you wonder how much PT would have cost were it not saddled with the extra cost (and dubious benefit) of "Physician Consultation".
Now there's a good cost study...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Spine Article: Cost effectiveness - June 23, 2005 8:55:00 AM
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UTDC
Posts: 221
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Just FYI,
The technique used in this case was not HVLA manipulation, but MET. I don't know why the authors chose to use the term manipulation vs. mobilization.
Jeff
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Re: Spine Article: Cost effectiveness - June 24, 2005 3:30:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Given the evidence for HVLA in the acute population, I wonder why also.
I think it gives another view as to the uncertainty of the definitions, ie no one really knows the difference between these two terms, which are often seen as mutually inclusive.
Oops, I guess some people in Arkansas know..
J
ps hi Jeff, long time no read...
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Spine Article: Cost effectiveness - June 24, 2005 4:55:00 AM
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Yogi
Posts: 403
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From: San Antonio, Tx., USA
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Whoa, Is this Dumb or what. What a load. At least from the abstract. #1. All it showed was that if someone spends some time with cLBP folks, doing something to and with them, they like it alot more than if no one does.
Good grief, is an Oswestry score sufficient diagnostic criteria for MET treatment, or even stabilization training. Was there any evaluation to choose an appropriate intervention?
Correct me if I'm wrong, if this isn't another of those wastes of time an money, to again prove something that is intuitively and logically true, i.e., doesn't need a study to prove it (#1)
But this study can easily be used to propagandize that therapy intervention is not useful for cLBP, right. Will they realize it's not even valid for that?
JMA, Jason, Alex, are there any flaws in my logic or is there other info I am unaware of that might change my conclusion?
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Re: Spine Article: Cost effectiveness - June 24, 2005 5:40:00 AM
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Alex Brenner PT MPT OCS
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Joined: February 29, 2004
From: Kentucky
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Yogi,
I haven't read this one entirely yet.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spine Article: Cost effectiveness - June 24, 2005 11:18:00 AM
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UTDC
Posts: 221
Joined: December 21, 2003
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"I think it gives another view as to the uncertainty of the definitions, ie no one really knows the difference between these two terms, which are often seen as mutually inclusive.
Oops, I guess some people in Arkansas know..
J
ps hi Jeff, long time no read..."
Jason,
Yes, all roads lead to Arkansas....I frequently turn to the guru's there whenever I am stumped. LOL.
I've been lurking mostly, I'm trying to stay out of the radiology cases unless I really have something of value to add- you guys have been kicking ass. I hope all is well.
Jeff
PS: from the study in question:
"Patients in this group attended one-hour evaluation, treatment, and exercise
sessions once weekly for 4 weeks. The therapy included manipulation using a
muscle-energy technique and motor control (i.e., stabilizing) exercises aimed
at correcting the lumbopelvic rhythm."
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Re: Spine Article: Cost effectiveness - June 24, 2005 4:55:00 PM
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jma
Posts: 2319
Joined: August 24, 2000
From: NY
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This kind of study can put a dent in LBP intervention as far as reimbursement issues are concerned, since cost-effectiveness is being analyzed here. Once you start talking about money, that gets the attention of medical insurance companies. This just adds to the mix.
JMA
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Re: Spine Article: Cost effectiveness - June 25, 2005 8:12:00 AM
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Yogi
Posts: 403
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From: San Antonio, Tx., USA
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JMA, right. Adds negatively to the mix, in my opinion.
However, UTDC says they were evaluated and treated, and therapy INCLUDED MET and lumbar stab., so apparently the interventions were chosen according to the results of the eval. and were not only those two. Thanks to UTDC for providing that info, which NEGATES my original conclusion from the abstact info. only.
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