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Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

By |November 10, 2016|Cost-Effectiveness|

Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

The Chiro.Org Blog


SOURCE:   Spine J. 2016 (Nov); 16 (11): 1292–1304

Brent Leininger, DC, MS, Christine McDonough, PT, PhD,
Roni Evans, DC, MS, PhD, Tor Tosteson, ScD,
Anna N.A. Tosteson, ScD, Gert Bronfort, DC, PhD

Integrative Health & Wellbeing Research Program,
Center for Spirituality & Healing,
University of Minnesota,
B296 Mayo Memorial Building,
420 Delaware St SE, Minneapolis, MN 55455, USA


BACKGROUND CONTEXT:   Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments.

PURPOSE:   This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA.

STUDY DESIGN/SETTING:   Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed.

PATIENT SAMPLE:   A total of 241 older adults (≥65 years) with chronic mechanical neck pain comprised the patient sample.

OUTCOME MEASURES:   The outcome measures were direct and indirect costs, neck pain, neck disability, SF–6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1–year time horizon.

METHODS:   This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308).

A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectiveness was a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

and the:

Chronic Neck Pain and Chiropractic Page

(more…)

Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

By |October 25, 2016|Cost-Effectiveness|

Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2011 (Jul); 20 (7): 1012–1023

Chung-Wei Christine Lin, Marion Haas, Chris G. Maher,
Luciana A. C. Machado, Maurits W. van Tulder

The George Institute for Global Health and
Sydney Medical School,
The University of Sydney,
PO Box M201, Missenden Rd,
Sydney, NSW 2050, Australia.


Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data.

Eleven studies were included; the majority of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

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Cost-Effectiveness of Non-Invasive and
Non-Pharmacological Interventions for Low Back Pain

By |August 24, 2016|Cost-Effectiveness, Low Back Pain|

Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain:
A Systematic Literature Review

The Chiro.Org Blog


SOURCE:   Applied Health Econ & Health Policy 2016 (Aug 22)

Lazaros Andronis, Philip Kinghorn, Suyin Qiao,
David G. T. Whitehurst, Susie Durrell, Hugh McLeod

Health Economics Unit,
Public Health Building,
University of Birmingham,
Birmingham, B15 2TT, UK.
l.andronis@bham.ac.uk


BACKGROUND:   Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

OBJECTIVES:   To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.

METHODS:   Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), ‘similar article’ searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms.

RESULTS:   Thirty-three studies were identified. Study interventions were categorised as:

(1) combined physical exercise and psychological therapy,

(2) physical exercise therapy only,

(3) information and education, and

(4) manual therapy.

Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Cost-Effectiveness of Chiropractic Page

(more…)

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

By |July 9, 2014|Cost-Effectiveness|

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jul); 37 (6): 343–362

Alexander Tsertsvadze, MD, MSc,
Christine Clar, PhD, Rachel Court, MA,
Aileen Clarke, MD, Hema Mistry, PhD,
Paul Sutcliffe, DPhil

Senior Research Fellow,
Warwick Medical School,
University of Warwick, Coventry, UK.


OBJECTIVES:   The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

METHODS:   A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

RESULTS:   Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

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Prevention of Low Back Pain: Effect, Cost-effectiveness, and Cost-utility of Maintenance Care – Study Protocol for a Randomized Clinical Trial

By |June 8, 2014|Cost-Effectiveness, Low Back Pain, Maintenance Care, Randomized Controlled Trial|

Prevention of Low Back Pain: Effect, Cost-effectiveness, and Cost-utility of Maintenance Care – Study Protocol for a Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Trials. 2014 (Apr 2);   15:   102

Andreas Eklund, Iben Axén, Alice Kongsted, Malin Lohela-Karlsson,
Charlotte Leboeuf-Yde, and Irene Jensen

Institute of Environmental Medicine,
Unit of Intervention and Implementation Research,
Karolinska Institutet, Nobels v13, S-171 77
Stockholm, Sweden. andreas.eklund@ki.se.


BACKGROUND:   Low back pain (LBP) is a prevalent condition and a socioeconomic problem in many countries. Due to its recurrent nature, the prevention of further episodes (secondary prevention), seems logical. Furthermore, when the condition is persistent, the minimization of symptoms and prevention of deterioration (tertiary prevention), is equally important. Research has largely focused on treatment methods for symptomatic episodes, and little is known about preventive treatment strategies.

METHODS/DESIGN:   This study protocol describes a randomized controlled clinical trial in a multicenter setting investigating the effect and cost-effectiveness of preventive manual care (chiropractic maintenance care) in a population of patients with recurrent or persistent LBP.Four hundred consecutive study subjects with recurrent or persistent LBP will be recruited from chiropractic clinics in Sweden. The primary outcome is the number of days with bothersome pain over 12 months. Secondary measures are self-rated health (EQ-5D), function (the Roland Morris Disability Questionnaire), psychological profile (the Multidimensional Pain Inventory), pain intensity (the Numeric Rating Scale), and work absence.The primary utility measure of the study is quality-adjusted life years and will be calculated using the EQ-5D questionnaire. Direct medical costs as well as indirect costs will be considered.

Subjects are randomly allocated into two treatment arms:

1) Symptom-guided treatment (patient controlled), receiving care when patients feel a need.

2) Preventive treatment (clinician controlled), receiving care on a regular basis.

Eligibility screening takes place in two phases: first, when assessing the primary inclusion/exclusion criteria, and then to only include fast responders, i.e., subjects who respond well to initial treatment. Data are collected at baseline and at follow-up as well as weekly, using SMS text messages.

There are more articles like this @ our:

Maintenance Care, Wellness and Chiropractic Page

(more…)

Chiropractic Cost-Effectiveness Supplement

By |August 17, 2013|Chiropractic Care, Chronic Pain, Cost-Effectiveness, Low Back Pain|

Chiropractic Cost-Effectiveness Supplement

The Chiro.Org Blog


SOURCE:   Virginia Chiropractic Association

Download the complete 29-Page Acrobat File


The following studies detail the cost effectiveness and overall efficacy of chiropractic care, and the procedures that doctors of chiropractic provide their patients.

This presentation is divided into several parts:

  • Background studies, detailing that LBP is much more complex than the literature leads us to believe;
  • Cost-Effectiveness Studies;
  • Worker’s Compensation Studies (National studies) and
  • Worker’s Compensation Studies (State specific studies)



GENERAL BACKGROUND STUDIES:


Prognosis in Patients with Recent Onset Low Back Pain in Australian Primary Care: Inception Cohort Study
British Medical Journal 2008 (Jul 7); 337: a171 ~ FULL TEXT

This study contradicts the Clinical Practice Guidelines that maintain that recovery from acute low back pain is usually rapid and complete.   Their findings with 973 consecutive primary care patients was that recovery was slow for most patients, and almost 1/3 of patients did not recover within one year (when following standard medical recommendations).

This study was designed to determine the one year prognosis of patients with low back pain. 973 patients with low back pain that had lasted less than 2 weeks completed a baseline questionnaire. Patients were reassessed through a phone interview at six weeks, three months and 12 months. The study found that the prognosis claimed in clinical guidelines was more favorable than the actual prognosis for the patients in the study. Recovery was slow for most patients and almost 1/3 of patients did not recover within one year.

          

Low Back Pain In A General Population. Natural Course And Influence Of Physical Exercise–A 5-Year Follow-Up
Spine. 2006 (Dec 15); 31 (26): 3045-51

This study contradicts the common belief that low back pain will extinguish with simple core exercises. This study provided significant benefits for only 1 out of 5 LPB sufferers.   Researchers followed 790 patients who initially sought care for low back pain from 70 different caregivers. After 5 years, only 21% of patients studied reported no continued pain while only 37% reported no disability. Pain and disability scores dropped significantly at 6 months, then remained flat at 2 yrs and 5 yrs. Nonspecific regular exercise did not affect recovery. Between 27% and 66% of the study population experienced a recurrence of low back pain.

          
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A Systematic Review and Meta-analysis of Efficacy, Cost-effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-back Pain

By |January 2, 2012|Low Back Pain, Neck Pain, Spinal Manipulation|

A Systematic Review and Meta-analysis of Efficacy, Cost-effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-back Pain

The Chiro.Org Blog


SOURCE:   Evid Based Complement Alternat Med [Epub 2011 Nov 24]

Andrea D. Furlan, Fatemeh Yazdi, Alexander Tsertsvadze, * Anita Gross, Maurits Van Tulder, Lina Santaguida, Joel Gagnier, Carlo Ammendolia, Trish Dryden, Steve Doucette, Becky Skidmore, Raymond Daniel, Thomas Ostermann, and Sophia Tsouros

Clinical Epidemiology Methods Centre,
Ottawa Hospital Research Institute,
University of Ottawa Evidence-Based Practice Center,
Box 208, Ottawa, ON, Canada K1H 8L6


Background: Back pain is a common problem and a major cause of disability and health care utilization.

Purpose: To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain.

Data Sources: Records without language restriction from various databases up to February 2010.

Data Extraction: The efficacy outcomes of interest were pain intensity and disability.

Data Synthesis: Reports of 147 randomized trials and 5 non-randomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.

Conclusions: CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.


Introduction:

Back pain is a general term that includes neck, thoracic, and lower-back spinal pain. In the majority of cases, the aetiology of back pain is unknown and therefore is considered as “nonspecific back pain”. Back pain is considered “specific” if its aetiology is known (e.g., radiculopathy, discogenic disease). Although back pain is usually self-limited and resolves within a few weeks, approximately 10% of the subjects develop chronic pain, which imposes large burden to the health-care system, absence from work, and lost productivity [1]. In a recent study, the direct costs of back pain related to physician services, medical devices, medications, hospital services, and diagnostic tests were estimated to be US$ 91 billion or US$ 46 per capita [2]. Indirect costs related to employment and household activities were estimated to be between US$ 7 billion and US$ 20 billion, or between US$25 and US$ 71 per capita, respectively [3–5]. One study published in 2007 showed that the 3-month prevalence of back and/or neck pain in USA was 31% (low-back pain: 34 million, neck pain: nine million, both back and neck pain: 19 million) [6]. (more…)

Chiropractic Cost-Effectiveness At Your Fingertips

By |June 26, 2011|Cost-Effectiveness, Research|

Chiropractic Cost-Effectiveness At Your Fingertips

The Chiro.Org Blog


SOURCE:   Virginia Chiropractic Association

The Path to Change in the US Healthcare System:
Chiropractic Cost-Effectiveness


The following is a collection of studies relating to the cost effectiveness and efficacy associated with chiropractic care and the procedures that doctors of chiropractic provide. The American Chiropractic Association, The International Chiropractic Association, The Congress of State Associations, and the Association of Chiropractic Colleges appreciate the opportunity to provide these materials for your review.


All These Articles And More Are Available On Our:
The Cost-Effectiveness of Chiropractic Page

BACKGROUND STUDIES: (Regarding Medical Management)

Prognosis in Patients With Recent Onset Low Back Pain in Australian Primary Care: Inception cohort study
British Medical Journal 2008 (Jul 7); 337: a171 ~ FULL TEXT

This study contradicts Clinical Practice Guidelines that suggest that recovery from an episode of recent onset low back pain is usually rapid and complete.   Their findings with 973 consecutive primary care patients was that recovery was slow for most patients, and almost 1/3 of patients did not recover within after one year, while following standard medical management. This study was designed to determine the one year prognosis of patients with low back pain. 973 patients with low back pain that had lasted less than 2 weeks completed a baseline questionnaire. Patients were reassessed through a phone interview at six weeks, three months and 12 months. The study found that the prognosis claimed in clinical guidelines was more favorable than the actual prognosis for the patients in the study.

(more…)

Chiropractic Cost-Effectiveness

By |March 16, 2011|Cost-Effectiveness, News|

Chiropractic Cost-Effectiveness

The Chiro.Org Blog


SOURCE:   Health Insights Today

By Daniel Redwood, DC


“Doctors of chiropractic are a vital part of our nation’s health care system. Your services have been proven both effective and cost-effective and every day you help countless Americans with a variety of health conditions.”

~ Kathleen Sebelius,
Secretary of Health and Human Services
2011 National Chiropractic Legislative Conference

Health care costs in the United States continue to rise and now account for 17.6% of the economy. In the public sector, Medicare and Medicaid budgets are under continual strain, while accelerating private sector insurance premium increases are pricing millions of American families out of the market each year.

Aside from outlawing pre-existing condition exclusions and providing premium subsidies for those who need them most, the Patient Protection and Affordable Care Act of 2010 (PPACA) empowers the Department of Health and Human Services to take a variety of steps toward controlling costs. But attempts to utilize these powers will trigger strong opposition from groups facing adverse impact to their bottom lines. Further complicating matters, the future of PPACA remains uncertain as opponents seek to vilify, defund and repeal it. (more…)

Cost-Effectiveness Revisited

By |June 14, 2010|Low Back Pain, Neck Pain, News|

Cost-Effectiveness Revisited

The Chiro.Org Blog


SOURCE:   The Chiropractic Report

David Chapman-Smith, LL.B (Hons)


As the United States faces the prospect of major reform to its healthcare system a dramatic new expert study from leading US health economists from Mercer Health and Benefits, and Harvard University analyses chiropractic management of back and neck pain and reports:

  • “Almost half of US patients with persistent back pain” seek chiropractic care.
  • “Low-back and neck pain are extremely common conditions that consume large amounts of healthcare resources”.
  • Effectiveness: chiropractic care is more effective than other modalities for treating low-back and neck pain”.
  • Cost-effectiveness: when considering effectiveness and cost together, chiropractic physician care for low-back and neck pain is highly cost-effective, and represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds”. (more…)

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