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Baumbach L, Feddern W, Kretzler B, Hajek A, König HH. Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations. SPORTS MEDICINE - OPEN 2024; 10:38. [PMID: 38613739 PMCID: PMC11016054 DOI: 10.1186/s40798-024-00713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. METHODS We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. RESULTS We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. CONCLUSIONS High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.
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Affiliation(s)
- Linda Baumbach
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Wiebke Feddern
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Lilje S, van Tulder M, Wykman A, Aboagye E, Persson U. Cost-effectiveness of specialised manual therapy versus orthopaedic care for musculoskeletal disorders: long-term follow-up and health economic model. Ther Adv Musculoskelet Dis 2023; 15:1759720X221147751. [PMID: 36742152 PMCID: PMC9896095 DOI: 10.1177/1759720x221147751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/11/2022] [Indexed: 02/01/2023] Open
Abstract
Background Physiotherapy is usually the first line of treatment for musculoskeletal disorders. If pain persists, an appointment with an orthopaedic surgeon is indicated, but many disorders for which patients are placed on orthopaedic waiting lists cannot be treated in an orthopaedic clinic. Specialised manual therapy, although not mainstream, can be an effective alternative to orthopaedic care, although its cost-effectiveness beyond 12 months is unknown. Objectives To perform an 8-year follow-up of the quality of life and costs of specialised manual therapy versus standard orthopaedic care for working-age patients with common nonsurgical musculoskeletal disorders referred to orthopaedic surgeons and to develop a health economic model. Design Cost-effectiveness study using Markov modelling. Methods The index group of a previously published pragmatic randomised controlled trial received a maximum of five treatment sessions of specialised manual therapy, while the control group received orthopaedic 'care as usual'. At 3, 6, 12 and 96 months, Health-Related Quality of Life and costs were measured with Short Form Health Survey 36, Short Form Health Survey 6D and Diagnostic Related Groups. An incremental cost-effectiveness ratio was calculated, a Markov model was developed and a sensitivity analysis was performed. Results Overall, 95% (n = 75) of the participants completed the 8-year follow-up. Recovery rates during the first 3 months ('per protocol') in the index and control group were 69% and 58%, respectively. The index group had 0.159 more gains in quality-adjusted life years and cost 40,270 SEK (€4027) less per patient over 8 years. The sensitivity analysis results were consistent with the main results. Conclusion Specialised manual therapy dominated standard care after 8 years. The results of this small but very first study are promising; therefore, further exploration within other health care professions, clinics and/or countries is required. Our study raises questions about the triaging of orthopaedic outpatients, cost-effectiveness and resource allocation. Registration Not applicable per the information provided by ClinicalTrials.gov. Plain Language Summary Specialised manual therapy is more cost-effective than 'care as usual' for working-age patients referred to an orthopaedist. This study provides an 8-year follow-up of the cost effects and quality of life of a previously published trial. Why was this study conducted? The standard care for musculoskeletal pain consists of exercises with a physiotherapist in primary care. If the pain persists, a referral to an orthopaedic clinic is often made. Many of these referrals are inappropriate because they concern pain from muscles and joints that do not benefit from surgery or the resources available in an orthopaedic clinic. There is a gap in competence and treatment between primary and specialised care that is costly, time- and resource-consuming and causes prolonged patient suffering. Although specialised manual therapy (MT) is effective, its use is not mainstream. Costs and effects after more than 12 months of treatment that may shorten waiting lists have never been evaluated. What did the researchers do? Quality of life and costs were compared in 75 patients with nonsurgical disorders referred to orthopaedic surgeons at 8 years after treatment with specialised MT or standard orthopaedic care. A health economics model for the probability of recovery was also developed and tested. What did the researchers find? Compared with the control group, the study participants treated with specialised MT had a better quality of life, required fewer health care interventions, underwent less surgery, incurred significantly lower costs and demonstrated an increased probability of recovery. What do these findings mean? It seems probable that using specialised MT for an old, well-known structural problem may yield better treatment effects at a significantly lower cost. Our study findings suggest that policy recommendations should focus on costs and effects rather than resource utilisation alone. The study is small and requires expansion using its economic health model.
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Affiliation(s)
| | - Maurits van Tulder
- Faculty Behavioral and Movement Sciences, Vrije
Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anders Wykman
- Orthopedic Clinic, Helsingborg Hospital, Lund
University, Lund, Sweden
| | - Emmanuel Aboagye
- Unit of Intervention and Implementation
Research for Worker Health, Institute of Environmental Medicine (IMM),
Karolinska Institute, Stockholm, Sweden
| | - Ulf Persson
- Swedish Institute for Health Economics, Lund
University, Lund, Sweden
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Aboagye E, Lilje S, Bengtsson C, Peterson A, Persson U, Skillgate E. Manual therapy versus advice to stay active for nonspecific back and/or neck pain: a cost-effectiveness analysis. Chiropr Man Therap 2022; 30:27. [PMID: 35578230 PMCID: PMC9109382 DOI: 10.1186/s12998-022-00431-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back and neck pain are the most common musculoskeletal disorders worldwide, and imply suffering and substantial societal costs, hence effective interventions are crucial. The aim of this study was to evaluate the cost-effectiveness of manual therapy compared with advice to stay active for working age persons with nonspecific back and/or neck pain. METHODS The two interventions were: a maximum of 6 manual therapy sessions within 6 weeks, including spinal manipulation/mobilization, massage and stretching, performed by a naprapath (index group), respectively information from a physician on the importance to stay active and on how to cope with pain, according to evidence-based advice, at 2 occasions within 3 weeks (control group). A cost-effectiveness analysis with a societal perspective was performed alongside a randomized controlled trial including 409 persons followed for one year, in 2005. The outcomes were health-related Quality of Life (QoL) encoded from the SF-36 and pain intensity. Direct and indirect costs were calculated based on intervention and medication costs and sickness absence data. An incremental cost per health related QoL was calculated, and sensitivity analyses were performed. RESULTS The difference in QoL gains was 0.007 (95% CI - 0.010 to 0.023) and the mean improvement in pain intensity was 0.6 (95% CI 0.068-1.065) in favor of manual therapy after one year. Concerning the QoL outcome, the differences in mean cost per person was estimated at - 437 EUR (95% CI - 1302 to 371) and for the pain outcome the difference was - 635 EUR (95% CI - 1587 to 246) in favor of manual therapy. The results indicate that manual therapy achieves better outcomes at lower costs compared with advice to stay active. The sensitivity analyses were consistent with the main results. CONCLUSIONS Our results indicate that manual therapy for nonspecific back and/or neck pain is slightly less costly and more beneficial than advice to stay active for this sample of working age persons. Since manual therapy treatment is at least as cost-effective as evidence-based advice from a physician, it may be recommended for neck and low back pain. Further health economic studies that may confirm those findings are warranted. Trial registration Current Controlled Trials ISRCTN56954776. Retrospectively registered 12 September 2006, http://www.isrctn.com/ISRCTN56954776 .
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Affiliation(s)
- Emmanuel Aboagye
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Stina Lilje
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Health Promoting Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden.
| | - Camilla Bengtsson
- Department of Health Promoting Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Anna Peterson
- Department of Health Promoting Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Ulf Persson
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Eva Skillgate
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Health Promoting Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
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Lilje S, Eklund A, Wykman A, Sundberg T, Skillgate E. Naprapathy versus orthopaedic standard care for common musculoskeletal disorders: an 8-year follow-up of a pragmatic randomized controlled trial in Sweden. Chiropr Man Therap 2021; 29:43. [PMID: 34727936 PMCID: PMC8561905 DOI: 10.1186/s12998-021-00400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a manual therapy (naprapathy) for common orthopaedic disorders. METHODS An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists (n = 78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected. The treatments lasted from January 2007 to November 2007. RESULTS N = 75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21.7 (95% CI: 9.1-34.3)), physical function (17.6 (6.7-28.4)), and QoLs (0.823 (95% CI: 0.785-0.862) compared with 0.713 (95% CI: 0.668-0.758)) were statistically significantly in favor of the experimental group (p-values < 0.01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1161 in the control group. CONCLUSIONS Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems. TRIAL REGISTRATION Not applicable, as per information given by ClinicalTrials.gov.
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Affiliation(s)
- Stina Lilje
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Valhallav. 91, 114 28, Stockholm, Sweden.
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels v. 13, 171 77, Stockholm, Sweden.
| | - Andreas Eklund
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels v. 13, 171 77, Stockholm, Sweden
| | - Anders Wykman
- Helsingborg Hospital, Lund University, Charlotte Yléns g. 10, 252 23, Lund, Sweden
| | - Tobias Sundberg
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Valhallav. 91, 114 28, Stockholm, Sweden
| | - Eva Skillgate
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Valhallav. 91, 114 28, Stockholm, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels v. 13, 171 77, Stockholm, Sweden
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Su X, Wang Z, Wu B, Song K, Chen Y, Zhang C, Xue C, Ge L, Liu Y. Care of abdominal skin in ankylosing spondylitis patients undergoing corrective spinal surgery. Exp Ther Med 2021; 22:1350. [PMID: 34659496 DOI: 10.3892/etm.2021.10785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/15/2020] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the effect of a new method of abdominal skin care on patients with ankylosing spondylitis (AS) undergoing orthopedic surgery. A total of 90 patients with AS and thoracolumbar kyphosis undergoing orthopedic surgery were randomly divided into two groups. Patients in the control group received routine care while those in experimental group received the following new treatment regimen: i) Vaseline cream was applied to the abdominal skin for 3-5 min every 6 h; ii) preoperative stretch exercises were encouraged and iii) 24 h after surgery, the patient was placed in a lateral decubitus position. The difference in abdominal pain levels and the size of tension blisters was the compared between the two groups. There was no difference in age, gender, disease course and kyphosis angle between two groups (P>0.05). Compared with the patients in the control group, those in test group experienced milder pain when evaluated by visual analogue score at 6, 18 and 30 h after surgery (3.6±1.2 vs. 4.5±1.8; 4.4±2.3 vs. 6.1±2.7; 4.1±2.1 vs. 4.1±2.1, P<0.05). Moreover, tension vesicles in the abdominal skin were significantly smaller in the treatment group than the control group (P<0.05). Optimal nursing may be the key to the reduction of the level of pain and occurrence of tension vacuoles in the abdominal skin.
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Affiliation(s)
- Xiaojing Su
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Zheng Wang
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Bing Wu
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Kai Song
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Yixiu Chen
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Chunzheng Zhang
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Chuanjuan Xue
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Lili Ge
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Yang Liu
- Department of Orthopedics, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
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Moretto N, Stute M, Sam S, Bhagwat M, Raymer M, Buttrum P, Banks M, Comans TA. A uniform data set for determining outcomes in allied health primary contact services in Australia. Aust J Prim Health 2020; 26:58-69. [PMID: 31954431 DOI: 10.1071/py18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
The project aim was to develop and implement a set of metrics to capture and demonstrate the performance of newly established allied health primary contact services. Selection of the metrics and performance indicators was guided by an existing state-wide data collection system and from a review of the published literature. The metrics were refined after consultation with a working group of health service managers and clinicians. The data collection and reporting framework were developed for use in allied health primary contact services and implemented at public health facilities in Queensland, Australia. The set of metrics consists of 18 process and outcome measures. Patient-reported metrics include the global rating of change scale and patient satisfaction. Service metrics include wait times; referral source; triage category; diagnosis; occasions of service; referrals and investigations initiated; effects; care duration; discharge status; waitlist reinstatement reasons; treatment non-completion reasons; and expedited care. Safety, patient demographics and service improvement metrics were included. The metrics will enable analysis of the effectiveness of allied health primary contact services and will facilitate reporting, advocacy, service improvement, service continuity and research. The metrics are suitable for use by all providers of allied health primary contact services in hospital and primary care settings.
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Affiliation(s)
- Nicole Moretto
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia; and Corresponding author
| | - Michelle Stute
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Sonia Sam
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Marita Bhagwat
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Maree Raymer
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Peter Buttrum
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Merrilyn Banks
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
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Stute M, Moretto N, Raymer M, Banks M, Buttrum P, Sam S, Bhagwat M, Comans T. Process to establish 11 primary contact allied health pathways in a public health service. AUST HEALTH REV 2019; 42:258-265. [PMID: 28483033 DOI: 10.1071/ah16206] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/17/2017] [Indexed: 11/23/2022]
Abstract
Objective Faced with longstanding and increasing demand for specialist out-patient appointments that was unable to be met through usual medical consultant led care, Metro North Hospital and Health Service in 2014-15 established 11 allied health primary contact out-patient models of care. Methods The models involved six different allied health professions and nine specialist out-patient departments. Results All the allied health models have been endorsed for continuation following demonstration of their contribution to managing demand on specialist out-patient services. Conclusion This paper describes key features of the allied health primary contact models of care and presents preliminary data including new case throughput, effect on wait times and enablers and challenges for clinic establishment. What is known about the topic? Allied health clinics have been demonstrated to result in high patient, referrer and consultant satisfaction, and are a cost-effective management strategy for wait list demand. In Queensland, physiotherapy-led orthopaedic clinics have been operating since 2005. What does this paper add? This paper describes the establishment of 11 allied health primary contact models of care in speciality out-patient areas including Ear, Nose and Throat, Gynaecology, Urology, Neurology, Neurosurgery, Orthopaedics and Plastic Surgery, and involving speech pathologists, audiologists, physiotherapists, occupational therapists and podiatrists as primary contact practitioners. Observations of enablers for and challenges to implementation are presented as key lessons. What are the implications for practitioners? The new allied health primary contact models of care described in this paper should be considered by health service executives, allied health leaders and specialist out-patient departments as one strategy to address unacceptably long specialist wait lists.
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Affiliation(s)
- Michelle Stute
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Nicole Moretto
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Maree Raymer
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Merrilyn Banks
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Peter Buttrum
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Sonia Sam
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Marita Bhagwat
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
| | - Tracy Comans
- Metro North Hospital and Health Service. Royal Brisbane and Women's Hospital, Butterfield Street Herston, Qld 4006, Australia. ; ; ;
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Tabell V, Tarkka IM, Holm LW, Skillgate E. Do adverse events after manual therapy for back and/or neck pain have an impact on the chance to recover? A cohort study. Chiropr Man Therap 2019; 27:27. [PMID: 31205681 PMCID: PMC6560736 DOI: 10.1186/s12998-019-0248-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background Manual therapy is a commonly used treatment for patients with back and neck pain. Studies have shown that manual therapy-related adverse events are mainly short in duration and mild or moderate by their intensity, affecting up to 50% of the patients. If the presence of adverse events has an impact on the chance to recover from back/neck pain is poorly understood. The aim of this study was to investigate if mild or moderate adverse events after manual therapy has an impact on the chance to recover from back/neck pain in men and women. Methods A prospective cohort study of 771 patients with at least three treatment sessions in a randomized controlled trial performed in January 2010 – December 2013. Adverse events within 24 h after each treatment were measured with questionnaires and categorized as: no, mild or moderate, based on bothersomeness. Outcome measure was the perceived recovery at seven weeks and at three months follow-up. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated by Logistic regression to investigate the associations between the exposure and outcome, and to test and adjust for potential confounding. Results There were no statistically significant associations observed between the experience of mild or moderate adverse events and being recovered at the seven weeks follow-up. The only statistically significant association observed at the three months follow-up was for mild adverse events in men with an OR of 2.44, 95% CI: 1.24–4.80 in comparison to men with no adverse events. Conclusion This study indicates that mild adverse events after manual therapy may be related to a better chance to recover in men. Trial registration The study is based on data from a trial registered in Current Controlled Trials (ISRCTN92249294).
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Affiliation(s)
- Vesa Tabell
- 1Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Ina M Tarkka
- 1Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Lena W Holm
- 2Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden
| | - Eva Skillgate
- 2Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden.,3Sophiahemmet University, Box 5605, SE-11485 Stockholm, Sweden.,Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, SE-11419 Stockholm, Sweden
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Lilje SC, Olander E, Berglund J, Skillgate E, Anderberg P. Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study. JMIR Mhealth Uhealth 2017; 5:e39. [PMID: 28360026 PMCID: PMC5391433 DOI: 10.2196/mhealth.7184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients’ experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. Objectives The aim of this study was to explore older persons’ common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. Methods A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi’s principles of psychological phenomenological analysis. Results The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. Conclusions It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed.
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Affiliation(s)
| | - Ewy Olander
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Johan Berglund
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Eva Skillgate
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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Marks D, Comans T, Bisset L, Scuffham PA. Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders: a systematic review. Physiotherapy 2016; 103:341-351. [PMID: 28801031 DOI: 10.1016/j.physio.2016.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 11/19/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is large variation in models-of-care involving the professional substitution of doctors with physiotherapists. OBJECTIVE To establish the impact upon patients and health services, of substituting doctors with physiotherapists in the management of common musculoskeletal disorders. DATA SOURCES Medline, CINAHL and ABI Complete databases, and hand-searching of related studies. STUDY SELECTION Randomised and non-randomised clinical trials, inter-rater reliability and comparative studies comparing the outcomes of usual care from doctors, with outcomes when the doctor was substituted with a physiotherapist. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers evaluated all studies using the Downs and Black Instrument. Meta-analysis was not possible due to study heterogeneity. A descriptive review was undertaken. RESULTS 14 studies of moderate to low quality met the inclusion criteria. Professional substitution with a physiotherapist causes no significant change to health outcomes and inconsistent variation in the use of healthcare resources. There is insufficient health economic data to determine overall efficiency. In the selected presentations studied, physiotherapists made similar diagnostic and management decisions to orthopaedic surgeons and patients are as, or more satisfied with a physiotherapist. LIMITATIONS Further high quality health and economic research is needed, in less selective patient populations, to determine the optimal role for physiotherapists. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Physiotherapists provide a professional alternative to doctors for musculoskeletal disorders but the health economic implications of this model are presently unclear. Systematic Review Registration Number PROSPERO (Registration number CRD42015027671).
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Affiliation(s)
- Darryn Marks
- Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Gold Coast, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
| | - Tracy Comans
- Menzies Health Institute Queensland, Griffith University, Australia; Metro North Hospital Health Service, Brisbane, Australia.
| | - Leanne Bisset
- Menzies Health Institute Queensland, Griffith University, Australia.
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Australia.
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Paanalahti K, Holm LW, Nordin M, Höijer J, Lyander J, Asker M, Skillgate E. Three combinations of manual therapy techniques within naprapathy in the treatment of neck and/or back pain: a randomized controlled trial. BMC Musculoskelet Disord 2016; 17:176. [PMID: 27107960 PMCID: PMC4842267 DOI: 10.1186/s12891-016-1030-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/09/2016] [Indexed: 11/29/2022] Open
Abstract
Background Manual therapy as spinal manipulation, spinal mobilization, stretching and massage are common treatment methods for neck and back pain. The objective was to compare the treatment effect on pain intensity, pain related disability and perceived recovery from a) naprapathic manual therapy (spinal manipulation, spinal mobilization, stretching and massage) to b) naprapathic manual therapy without spinal manipulation and to c) naprapathic manual therapy without stretching for male and female patients seeking care for back and/or neck pain. Method Participants were recruited among patients, ages 18–65, seeking care at the educational clinic of Naprapathögskolan - the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 1057) were randomized to one of three treatment arms a) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage), b) manual therapy excluding spinal manipulation and c) manual therapy excluding stretching. The primary outcomes were minimal clinically important improvement in pain intensity and pain related disability. Treatments were provided by naprapath students in the seventh semester of eight total semesters. Generalized estimating equations and logistic regression were used to examine the association between the treatments and the outcomes. Results At 12 weeks follow-up, 64 % had a minimal clinically important improvement in pain intensity and 42 % in pain related disability. The corresponding chances to be improved at the 52 weeks follow-up were 58 % and 40 % respectively. No systematic differences in effect when excluding spinal manipulation and stretching respectively from the treatment were found over 1 year follow-up, concerning minimal clinically important improvement in pain intensity (p = 0.41) and pain related disability (p = 0.85) and perceived recovery (p = 0.98). Neither were there disparities in effect when male and female patients were analyzed separately. Conclusion The effect of manual therapy for male and female patients seeking care for neck and/or back pain at an educational clinic is similar regardless if spinal manipulation or if stretching is excluded from the treatment option. Trial registration Current Controlled Trials ISRCTN92249294
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Affiliation(s)
- Kari Paanalahti
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.,Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.,Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3 M6, Canada
| | - Margareta Nordin
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.,Occupational and Industrial Orthopaedic Center (OIOC), NYU Hospital for Joint Diseases, New York University Langone Medical Center, 63 Downing Street, New York, NY, 10014, USA
| | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden
| | - Jessica Lyander
- Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden
| | - Martin Asker
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.,Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden
| | - Eva Skillgate
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden. .,Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden.
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12
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Skillgate E, Bill AS, Côté P, Viklund P, Peterson A, Holm LW. The effect of massage therapy and/or exercise therapy on subacute or long-lasting neck pain--the Stockholm neck trial (STONE): study protocol for a randomized controlled trial. Trials 2015; 16:414. [PMID: 26377322 PMCID: PMC4573492 DOI: 10.1186/s13063-015-0926-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neck pain is a major health problem in populations worldwide and an economic burden in modern societies due to its high prevalence and costs in terms of health care expenditures and lost productivity. Massage and exercise therapy are widely used management options for neck pain. However, there is a lack of scientific evidence regarding their effectiveness for subacute and long-lasting neck pain. This study protocol describes a randomized controlled trial aiming to determine the effect of massage and/or exercise therapy on subacute and long-lasting neck pain over the course of 1 year. METHODS/DESIGN A randomized controlled trial in which at least 600 study participants with subacute or long-lasting nonspecific neck pain will be recruited and randomly allocated to one of four treatment arms: massage therapy (A), exercise therapy (B), exercise therapy plus massage therapy (C) and advice to stay active (D). The study has an E-health approach, and study participants are being recruited through advertising with a mix of traditional and online marketing channels. Web-based self-report questionnaires measure the main outcomes at 7, 12, 26 and 52 weeks after inclusion. The primary outcomes are a clinically important improvement in pain intensity and pain-related disability at follow-up, measured with a modified version of the Chronic Pain Questionnaire (CPQ). The secondary outcomes are global improvement, health-related quality of life (EQ-5D), sick leave, drug consumption and healthcare utilization. Adverse events are measured by questionnaires at return visits to the clinic, and automated text messages (SMSes) survey neck pain intensity and pain-related disability every week over one year. DISCUSSION The results of this study will provide clinicians and stakeholders much needed knowledge to plan medical care for subacute and long-lasting neck pain disorders. TRIAL REGISTRATION Current Controlled Trials ISRCTN01453590. Date of registration: 3 July 2014.
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Affiliation(s)
- Eva Skillgate
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden. .,Naprapathögskolan, Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, SE-11419, Stockholm, Sweden.
| | - Anne-Sylvie Bill
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden.
| | - Pierre Côté
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada. .,Faculty of Health Sciences, University of Ontario, Institute of Technology, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada.
| | - Peter Viklund
- Naprapathögskolan, Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, SE-11419, Stockholm, Sweden.
| | - Anna Peterson
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden.
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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Lilje S, Genberg M, Aldudjaili H, Skillgate E. Pain relief in a young woman with adhesive capsulitis after manual manipulation of the acromioclavicular joint for remaining symptoms after mobilisation under anaesthesia. BMJ Case Rep 2014; 2014:bcr2014207199. [PMID: 25385565 PMCID: PMC4225262 DOI: 10.1136/bcr-2014-207199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/03/2022] Open
Abstract
Adhesive capsulitis is a painful condition with a prevalence of 2-5%. There is a lack of evidence for its aetiology and for conventional treatment and cost effects. This study describes the treatment effects of manual manipulation of the acromioclavicular joint for adhesive capsulitis in a young woman for persisting pain after mobilisation of the glenohumeral joint under anaesthesia. Primary outcomes were pain and physical function, measured by a visual analogue scale and the SF36 health survey. Secondary outcomes were sleep pattern, medication and perceived recovery. The mobility after manipulation under anaesthesia: elevation 55° and no improvement in pain. After manual manipulation: unrestricted elevation and significant pain relief. The patient no longer suffered from sleeping disorders and ceased all medication. Considering the lack of knowledge in aetiology and treatment, specialised manual examination of the acromioclavicular joint should be considered early in patients diagnosed with adhesive capsulitis.
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Affiliation(s)
- Stina Lilje
- Department of Health Care Sciences, Blekinge Institute of Technology, Karlskrona, Blekinge, Sweden
| | - Madeleine Genberg
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Hassan Aldudjaili
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Eva Skillgate
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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