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.
RCT Entities:
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.
Authors: Keith T Palmer; Elizabeth C Harris; Cathy Linaker; Mary Barker; Wendy Lawrence; Cyrus Cooper; David Coggon Journal: Rheumatology (Oxford) Date: 2011-03-16 Impact factor: 7.580
Authors: Santoshi S Indrakanti; Michael H Weber; Steven K Takemoto; Serena S Hu; David Polly; Sigurd H Berven Journal: Clin Orthop Relat Res Date: 2012-04 Impact factor: 4.176
Authors: Peter M Wayne; Julie E Buring; David M Eisenberg; Kamila Osypiuk; Brian J Gow; Roger B Davis; Claudia M Witt; Thomas Reinhold Journal: J Altern Complement Med Date: 2019-03 Impact factor: 2.579
Authors: Luciana G Macedo; Bruno T Saragiotto; Tiê P Yamato; Leonardo O P Costa; Luciola C Menezes Costa; Raymond W J G Ostelo; Christopher G Maher Journal: Cochrane Database Syst Rev Date: 2016-02-10
Authors: Sidney M Rubinstein; Marienke van Middelkoop; Ton Kuijpers; Raymond Ostelo; Arianne P Verhagen; Michiel R de Boer; Bart W Koes; Maurits W van Tulder Journal: Eur Spine J Date: 2010-03-14 Impact factor: 3.134
Authors: Marienke van Middelkoop; Sidney M Rubinstein; Ton Kuijpers; Arianne P Verhagen; Raymond Ostelo; Bart W Koes; Maurits W van Tulder Journal: Eur Spine J Date: 2010-07-18 Impact factor: 3.134
Authors: Chung-Wei Christine Lin; Marion Haas; Chris G Maher; Luciana A C Machado; Maurits W van Tulder Journal: Eur Spine J Date: 2011-01-13 Impact factor: 3.134
Authors: Bruno T Saragiotto; Christopher G Maher; Tiê P Yamato; Leonardo O P Costa; Luciola C Menezes Costa; Raymond W J G Ostelo; Luciana G Macedo Journal: Cochrane Database Syst Rev Date: 2016-01-08