A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States

doi:10.1186/s12913-015-1140-5

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BMC Health Serv Res. 2015; 15: 474.

Published online 2015 Oct 19. doi: 10.1186/s12913-015-1140-5

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Table 5

Study design for cost comparisons also examining clinical outcomes

First author	Year	Location/Study design/Eligibility/Study period	Inclusion	Exclusion	Chiropractic group(s)	Clinical outcomes/Maximum follow-up
Bronfort [46]	2000	Minnesota/Pilot randomized controlled trial/Seeking care at chiropractic college clinic/3/1/1998 - 3/1/1999	1. Sciatica; 2. 2–12 weeks duration; 3. Age 20–65; 4. QTF categories 2; 3; 4; 6	1. QTF category 5, 7, or 11; 2. Progressive neurologic deficits; 3. Lumbar surgery; 4. Atherosclerosis or aneurysm; 5. Joint instability; 6. Ankylosing spondylitis; 7. Osteopenia; 8. Blood clotting disorders; 9. Substance abuse; 10. Litigation; 11. Ongoing treatment for LBP; 12. History of gastrointestinal events; 13. Renal insufficiency; 14. Corticosteroids; 15. Average pain score of <30 %; 16. Pregnant or nursing	Chiropractic care (i.e. SMT, massage, traction, self-care instruction from a PT)	Pain, Physical function, Satisfaction/3 months
Carey [40]	1995	North Carolina/Prospective observational/Seeking care from randomly selected HCPs/6/1/1992 - 3/1/1993	1. Low back pain; 2. <10 weeks duration; 3. Spoke English; 4. Own a telephone	1. Previous care for LBP; 2. History of back surgery; 3. History of cancer; 4. Pregnancy	1. Urban chiropractic care	Physical function,
Carey [40]	1995				2. Rural chiropractic care (Both groups received SMT, heat, cold, diathermy, ultrasound, EMS, traction, or OTC drugs)	Satisfaction/6 months
Cherkin [44]	1998	Washington/Comparative randomized controlled trial/Seeking care at 2 primary care clinics with staff-model HMO/11/1/1993 - 9/1/1995	1. Low back pain; 2. >7 days after seeing PCP; 3. Age 20–64; 4. Saw PCP for low back pain	1. Mild or no pain 7 days after initial visit; 2. Back surgery; 3. Sciatica; 4. Systemic or visceral causes of pain; 5. Corticosteroids; 6. Pregnancy; 7. Claims or litigation; 8. Visits to practitioners other than PCPs	Chiropractic care (i.e. SMT, ice, massage, exercise, or manipulation of hip, pelvis, or ischium)	Pain, Physical function,
Cherkin [44]	1998					Satisfaction/24 months
Haas [41]	2005	Oregon and Washington/Prospective, non-randomized observational/Seeking care from 51 chiropractic clinics and 14 medical clinics/12/8/1994 - 6/30/1996	1. Low back pain of mechanical origin; 2. Acute or chronic; 3. Minimum 18 years of age; 4. English literate; 5. Ambulatory	1. Care from same provider type in previous 6 weeks; 2. Pregnancy; 3. Contraindications to spinal manipulation	Chiropractic care (i.e. SMT, physical modalities, exercise, self-care)	Pain, Physical function,
Haas [41]	2005					Satisfaction/12 months
Kominski [45]	2005	California/Randomized controlled trial/Seeking care at 3 HMOs/10/30/1995 - 11/9/1998	1. Low back pain (+/− leg symptoms); 2. Any duration; 3. Age 18 or older; 4. No treatment for LBP in previous month; 5. 18 month follow-up data available	1. Fracture, tumor, infection, spondyloarthropathy; 2. Cauda equina syndrome or progressive muscle weakness; 3. Severe coexisting condition; 4. Blood coagulation disorder; 5. Planning to relocate; 6. Not easily accessible by telephone; 7. Could not read English; 8. Third-party liability for LBP	1. Chiropractic care (SMT, back care instruction, exercise)	Pain, Physical function/18 months
Kominski [45]	2005				2. Chiropractic care + physical modalities (i.e. heat, cold, ultrasound, EMS)	Pain, Physical function/18 months
Sharma [43]	2009	Oregon and Washington/Prospective, non-randomized, observational/Seeking care from 51 chiropractic clinics and 14 medical clinics/12/8/1994 - 6/30/1996	1. Low back pain of mechanical origin; 2. Acute or chronic; 3. Minimum 18 years of age; 4. Ambulatory; 5. English literate	1. Care from same type of provider in previous 6 weeks; 2. Pregnant; 3. Contraindications to spinal manipulation	Chiropractic care (i.e. SMT)	Pain/12 months
Stano [42]	2002	Oregon and Washington/Prospective, non-randomized observational/Seeking care from 51 chiropractic clinics and 14 medical clinics/12/8/1994 - 6/30/1996	1. Low back pain of mechanical origin; 2. Acute or chronic; 3. Minimum 18 years of age; 4. English literate; 5. Complete cost data available; 6. Ambulatory; 7. 1 year VAS and ODI available^a	1. Pregnancy; 2. Malignancy, infection, vertebral fracture, lumbar instability; 3. Low back surgery in previous year^a	Chiropractic care (no details reported)	Pain, Physical function/12 months

^aeligibility criteria reported in separate study [48]

EMS electrical muscle stimulation, ESI epidural steroid injection, HCP health care provider, HMO health maintenance organization, LBP low back pain, NSAID non-steroidal anti-inflammatory drug, ODI Oswestry Disability Index, OTC over-the-counter, PCP primary care provider, PT physical therapist, QTF Quebec Task Force, SMT spinal manipulation therapy, VAS visual analog scale