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Lystad RP, Brown BT, Swain MS, Engel RM. Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. Chiropr Man Therap 2020; 28:49. [PMID: 32951611 PMCID: PMC7504850 DOI: 10.1186/s12998-020-00338-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Better understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. METHODS Data regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008-2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008-2012 and 2013-2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period. RESULTS A cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013-2017 than 2008-2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013-2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017. CONCLUSION Service provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Michael S Swain
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Elder C, DeBar L, Ritenbaugh C, Dickerson J, Vollmer WM, Deyo RA, Johnson ES, Haas M. Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain. J Gen Intern Med 2018; 33:1469-1477. [PMID: 29943109 PMCID: PMC6108992 DOI: 10.1007/s11606-018-4539-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/27/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored. OBJECTIVE To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain. STUDY DESIGN Prospective cohort study using propensity score-matched controls. PARTICIPANTS Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months. MAIN MEASURES Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care. KEY RESULTS Both groups' (N = 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed. (severity - 0.10 (95% CI - 0.30, 0.10), interference - 0.07 (- 0.31, 0.16), bothersomeness - 0.1 (- 0.39, 0.19)). After controlling for variances in baseline costs, total costs during the 6-month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group ($1996 [SD = 3874] vs $1086 [SD = 1212], p = .034). Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p = .072). CONCLUSIONS We found no statistically significant difference between the two groups in either patient-reported or economic outcomes. As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense.
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Affiliation(s)
- Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR, USA.
| | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - John Dickerson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | - Eric S Johnson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mitchell Haas
- Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
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Essex H, Parrott S, Atkin K, Ballard K, Bland M, Eldred J, Hewitt C, Hopton A, Keding A, Lansdown H, Richmond S, Tilbrook H, Torgerson D, Watt I, Wenham A, Woodman J, MacPherson H. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PLoS One 2017; 12:e0178918. [PMID: 29211741 PMCID: PMC5718562 DOI: 10.1371/journal.pone.0178918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 05/19/2017] [Indexed: 02/01/2023] Open
Abstract
Objectives To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. Methods An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure–the Northwick Park Neck Pain Questionnaire (NPQ). Results In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. Conclusions In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.
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Affiliation(s)
- Holly Essex
- Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Karl Atkin
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, London, United Kingdom
| | - Martin Bland
- Department of Health Sciences, University of York, York, United Kingdom
| | - Janet Eldred
- Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ann Hopton
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ada Keding
- Department of Health Sciences, University of York, York, United Kingdom
| | - Harriet Lansdown
- Department of Health Sciences, University of York, York, United Kingdom
- British Acupuncture Council, London, United Kingdom
| | - Stewart Richmond
- Sydera Research Associates, Market Weighton, York, United Kingdom
| | - Helen Tilbrook
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Torgerson
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ian Watt
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Aniela Wenham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Julia Woodman
- Department of Health Sciences, University of York, York, United Kingdom
- Society of Teachers of the Alexander Technique, London, United Kingdom
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, United Kingdom
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Harper B, Jagger K, Aron A, Steinbeck L, Stecco A. A commentary review of the cost effectiveness of manual therapies for neck and low back pain. J Bodyw Mov Ther 2017; 21:684-691. [PMID: 28750984 DOI: 10.1016/j.jbmt.2016.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/14/2016] [Accepted: 09/28/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND & PURPOSE Neck and low back pain (NLBP) are global health problems, which diminish quality of life and consume vast economic resources. Cost effectiveness in healthcare is the minimal amount spent to obtain acceptable outcomes. Studies on manual therapies often fail to identify which manual therapy intervention or combinations with other interventions is the most cost effective. The purpose of this commentary is to sample the dialogue within the literature on the cost effectiveness of evidence-based manual therapies with a particular focus on the neck and low back regions. METHODS This commentary identifies and presents the available literature on the cost effectiveness of manual therapies for NLBP. Key words searched were neck and low back pain, cost effectiveness, and manual therapy to select evidence-based articles. Eight articles were identified and presented for discussion. RESULTS The lack of homogeneity, in the available literature, makes difficult any valid comparison among the various cost effectiveness studies. DISCUSSION Potential outcome bias in each study is dependent upon the lens through which it is evaluated. If evaluated from a societal perspective, the conclusion slants toward "adequate" interventions in an effort to decrease costs rather than toward the most efficacious interventions with the best outcomes. When cost data are assessed according to a healthcare (or individual) perspective, greater value is placed on quality of life, the patient's beliefs, and the "willingness to pay."
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Affiliation(s)
- Brent Harper
- Department of Physical Therapy, Radford University, VA, USA
| | - Kristen Jagger
- Department of Physical Therapy, Radford University, VA, USA
| | - Adrian Aron
- Department of Physical Therapy, Radford University, VA, USA
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Kim CG, Mun SJ, Kim KN, Shin BC, Kim NK, Lee DH, Lee JH. Economic evaluation of manual therapy for musculoskeletal diseases: a protocol for a systematic review and narrative synthesis of evidence. BMJ Open 2016; 6:e010556. [PMID: 27178973 PMCID: PMC4874156 DOI: 10.1136/bmjopen-2015-010556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Manual therapy is the non-surgical conservative management of musculoskeletal disorders using the practitioner's hands on the patient's body for diagnosing and treating disease. The aim of this study is to systematically review trial-based economic evaluations of manual therapy relative to other interventions used for the management of musculoskeletal diseases. METHODS AND ANALYSIS Randomised clinical trials (RCTs) on the economic evaluation of manual therapy for musculoskeletal diseases will be included in the review. The following databases will be searched from their inception: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Econlit, Mantis, Index to Chiropractic Literature, Science Citation Index, Social Science Citation Index, Allied and Complementary Medicine Database (AMED), Cochrane Database of Systematic Reviews (CDSR), National Health Service Database of Abstracts of Reviews of Effects (NHS DARE), National Health Service Health Technology Assessment Database (NHS HTA), National Health Service Economic Evaluation Database (NHS EED), CENTRAL, five Korean medical databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS), DBPIA, Korean Traditional Knowledge Portal (KTKP) and KoreaMed) and three Chinese databases (China National Knowledge Infrastructure (CNKI), VIP and Wanfang). The evidence for the cost-effectiveness, cost-utility and cost-benefit of manual therapy for musculoskeletal diseases will be assessed as the primary outcome. Health-related quality of life and adverse effects will be assessed as secondary outcomes. We will critically appraise the included studies using the Cochrane risk of bias tool and the Drummond checklist. Results will be summarised using Slavin's qualitative best-evidence synthesis approach. ETHICS AND DISSEMINATION The results of the study will be disseminated via a peer-reviewed journal and/or conference presentations. TRIAL REGISTRATION NUMBER PROSPERO CRD42015026757.
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Affiliation(s)
- Chang-Gon Kim
- Department of Rehabilitation Medicine, College of Korean Medicine, Won-Kwang University, Iksan, Korea
| | - Su-Jeong Mun
- Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Ka-Na Kim
- Department of Neuropsychiatry, College of Korean Medicine, Kyung-Hee University, Seoul, Korea
| | - Byung-Cheul Shin
- Third Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Nam-Kwen Kim
- Department of Ophthalmology, Otolaryngology and Dermatology, School of Korean Medicine, Pusan National University, Yangsan, Korea
| | - Dong-Hyo Lee
- Evidence-Based Healthcare Research Collaborating Center, College of Korean Medicine, Woosuk University, Jeonju, Korea
- Department of Ophthalmology, Otolaryngology and Dermatology, College of Korean Medicine, Woosuk University, Jeonju, Korea
| | - Jung-Han Lee
- Department of Rehabilitation Medicine, College of Korean Medicine, Won-Kwang University, Iksan, Korea
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Chen W, Cui X, Zhang J, Wang J. A cable-driven wrist robotic rehabilitator using a novel torque-field controller for human motion training. Rev Sci Instrum 2015; 86:065109. [PMID: 26133875 DOI: 10.1063/1.4923089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Rehabilitation technologies have great potentials in assisted motion training for stroke patients. Considering that wrist motion plays an important role in arm dexterous manipulation of activities of daily living, this paper focuses on developing a cable-driven wrist robotic rehabilitator (CDWRR) for motion training or assistance to subjects with motor disabilities. The CDWRR utilizes the wrist skeletal joints and arm segments as the supporting structure and takes advantage of cable-driven parallel design to build the system, which brings the properties of flexibility, low-cost, and low-weight. The controller of the CDWRR is designed typically based on a virtual torque-field, which is to plan "assist-as-needed" torques for the spherical motion of wrist responding to the orientation deviation in wrist motion training. The torque-field controller can be customized to different levels of rehabilitation training requirements by tuning the field parameters. Additionally, a rapidly convergent parameter self-identification algorithm is developed to obtain the uncertain parameters automatically for the floating wearable structure of the CDWRR. Finally, experiments on a healthy subject are carried out to demonstrate the performance of the controller and the feasibility of the CDWRR on wrist motion training or assistance.
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Affiliation(s)
- Weihai Chen
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Xiang Cui
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Jianbin Zhang
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Jianhua Wang
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
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Reid SA, Rivett DA, Katekar MG, Callister R. Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: protocol of a randomised controlled trial. BMC Musculoskelet Disord 2012; 13:201. [PMID: 23078200 PMCID: PMC3488326 DOI: 10.1186/1471-2474-13-201] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 09/26/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Cervicogenic dizziness is a disabling condition characterised by postural unsteadiness that is aggravated by cervical spine movements and associated with a painful and/or stiff neck. Two manual therapy treatments (Mulligan's Sustained Natural Apophyseal Glides (SNAGs) and Maitland's passive joint mobilisations) are used by physiotherapists to treat this condition but there is little evidence from randomised controlled trials to support their use. The aim of this study is to conduct a randomised controlled trial to compare these two forms of manual therapy (Mulligan glides and Maitland mobilisations) to each other and to a placebo in reducing symptoms of cervicogenic dizziness in the longer term and to conduct an economic evaluation of the interventions. METHODS Participants with symptoms of dizziness described as imbalance, together with a painful and/or stiff neck will be recruited via media releases, advertisements and mail-outs to medical practitioners in the Hunter region of NSW, Australia. Potential participants will be screened by a physiotherapist and a neurologist to rule out other causes of their dizziness. Once diagnosed with cervciogenic dizziness, 90 participants will be randomly allocated to one of three groups: Maitland mobilisations plus range-of-motion exercises, Mulligan SNAGs plus self-SNAG exercises or placebo. Participants will receive two to six treatments over six weeks. The trial will have unblinded treatment but blinded outcome assessments. Assessments will occur at baseline, post-treatment, six weeks, 12 weeks, six months and 12 months post treatment. The primary outcome will be intensity of dizziness. Other outcome measures will be frequency of dizziness, disability, intensity of cervical pain, cervical range of motion, balance, head repositioning, adverse effects and treatment satisfaction. Economic outcomes will also be collected. DISCUSSION This paper describes the methods for a randomised controlled trial to evaluate the effectiveness of two manual therapy techniques in the treatment of people with cervicogenic dizziness for which there is limited established evidence-based treatment. TRIAL REGISTRATION ACTRN12611000073909.
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Affiliation(s)
- Susan A Reid
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Darren A Rivett
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michael G Katekar
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Robin Callister
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
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Boardman A, Jayawardena A, Oprescu F, Cook T, Morcuende JA. The Ponseti method in Latin America: initial impact and barriers to its diffusion and implementation. Iowa Orthop J 2011; 31:30-35. [PMID: 22096416 PMCID: PMC3215110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Ponseti method for correcting clubfoot is a safe, effective, and minimally invasive treatment that has recently been implemented in Latin America. This study evaluates the initial impact and unique barriers to the diffusion of the Ponseti method throughout this region. Structured interviews were conducted with 30 physicians practicing the Ponseti method in three socioeconomically diverse countries: Chile, Peru and Guatemala. Since learning the Ponseti method, these physicians have treated approximately 1,740 clubfoot patients, with an estimated 1,705 (98%) patients treated using the Ponseti method, and 35 (2%) patients treated using surgical techniques. The barriers were classified into the following themes: physician education, health care system of the country, culture and beliefs of patients, physical distance and transport, financial barriers for patients, and parental compliance with the method. The results yielded several common barriers throughout Latin America including lack of physician education, physical distance to the treatment centers, and financial barriers for patients. Information from this study can be used to inform, and to implement and evaluate specific strategies to improve the diffusion of the Ponseti method for treating clubfoot throughout Latin America.
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Affiliation(s)
- Allison Boardman
- Department of Orthopaedic Surgery and Rehabilitation, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
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Ferreira LFA, Nogueira MP, Pereira JCR, Duarte PS. Comparison of hospital costs and duration of treatment with two different clubfoot protocols. Iowa Orthop J 2011; 31:49-51. [PMID: 22096419 PMCID: PMC3215113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Non-drug management of chronic low back pain. Drug Ther Bull 2009; 47:102-7. [PMID: 19734192 DOI: 10.1136/dtb.2009.08.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Estimates suggest that, at any one time, 12-33% of the population have back pain. About 5% of a GP's workload involves consultations for the condition, and around 32% of patients who first present with back pain consult again within 3 months. Also, most will still have some pain or disability 1 year after consultation. Indeed, patients who have been off work with chronic back pain for 1-2 years are unlikely to return to any form of work in the foreseeable future, whatever treatment they receive. Here we discuss the place of non-drug management for patients with the condition.
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Abstract
UNLABELLED Both private and socialized healthcare systems require treatments to be not only effective, but also cost-efficient. Although the Ponseti method of clubfoot treatment is effective, its cost-effectiveness has not been demonstrated. We compared the difference in resource use between two prospective cohorts treated for clubfoot by either the Ponseti method or below-knee casting followed by primary surgical release in the socialized healthcare system of New Zealand. Using these cohorts and US billing data, costs of treating these cohorts in the US healthcare system were also calculated. Treatment of initial deformity, recurrences, and complications in both cohorts were included in the final assessment. Twenty-six patients (40 feet) were enrolled in the Ponseti cohort and 29 (46 feet) in the primary surgical cohort. For most patients, the Ponseti method was more cost-effective than the primary surgical treatment in both healthcare systems. The cost of treating both cohorts was lower in the socialized system than in the US healthcare system. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matthew A Halanski
- Helen DeVos Children's Hospital, 1425 Michigan Street NE, Suite D, Grand Rapids, MI 49503, USA.
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Niemistö L, Rissanen P, Sarna S, Lahtinen-Suopanki T, Lindgren KA, Hurri H. 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. Spine (Phila Pa 1976) 2005; 30:1109-15. [PMID: 15897822 DOI: 10.1097/01.brs.0000162569.00685.7b] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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 chi2) 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.
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Affiliation(s)
- Leena Niemistö
- Orthopaedic Hospital Orton, Invalid Foundation, Helsinki, Finland.
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Abstract
STUDY DESIGN A randomized clinical trial with blinded assessment. OBJECTIVES To investigate the clinical efficacy of 2 active interventions for patients with chronic low back pain. SUMMARY OF BACKGROUND DATA Manual therapy and exercise prescription are treatments frequently prescribed for patients with chronic low back pain. The evidence for the relative benefit of these treatments is limited, and questions concerning the most appropriate type of intervention remain unanswered. METHODS Eighty patients with chronic low back pain (>3 months) were randomized to one of the following treatments, involving 8 treatments over 8 weeks; 1) one-to-one treatment involving 30 minutes of manual therapy (mobilizations to the spine) and spinal stabilization exercises, and 2) a 10 station exercise class involving aerobic exercises, spinal stabilization exercises, and manual therapy. Three physiotherapists led the hour long group with a maximum of 10 patients. Questionnaires were completed, and physical measurements were taken by a blinded observer before randomization, at the completion of treatment, and at 6 months and 12 months after the completion of treatment. The intention-to-treat principle was used in data analysis. RESULTS Eleven patients dropped out of the individual treatment sessions and 7 dropped out of the exercise group. There was a significant reduction (reduced disability) in the questionnaire score in both groups, and there were significant increases in range for all the physical movements tested in both groups. The exercise group was 40% more cost effective than the individual treatments. CONCLUSION Both forms of intervention were associated with significant improvement. On-going clinical research is necessary to provide guidance as to the clinical efficacy of various forms of intervention.
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Affiliation(s)
- Jeremy S Lewis
- Therapy Department, Chelsea & Westminster Healthcare National Health Service Trust, London, United Kingdom.
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Affiliation(s)
- M M Sran
- Division of Orthopaedic Engineering Research, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, VGH Research Pavilion, Room 500, 828 W 10th Ave, Vancouver, BC V5Z 1L8 Canada.
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