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jma -> Spine Article: Cost effectiveness (May 29, 2005 6:15:00 AM)
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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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