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Cost-effectiveness of Spinal Manipulation, Exercise, and Self-management for Spinal Pain Using an Individual Participant Data Meta-analysis Approach

By |November 15, 2018|Cost-Effectiveness|

Cost-effectiveness of Spinal Manipulation, Exercise, and Self-management for Spinal Pain Using an Individual Participant Data Meta-analysis Approach: A Study Protocol

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2018; 26: 46

Brent Leininger, Gert Bronfort, Roni Evans, James Hodges, Karen Kuntz and John A. Nyman

Integrative Health & Wellbeing Research Program,
Earl E. Bakken Center for Spirituality & Healing,
University of Minnesota,
420 Delaware St SE,
Minneapolis, MN 55455, USA


Background   Spinal pain is a common and disabling condition with considerable socioeconomic burden. Spine pain management in the United States has gathered increased scrutiny amidst concerns of overutilization of costly and potentially harmful interventions and diagnostic tests. Conservative interventions such as spinal manipulation, exercise and self-management may provide value for the care of spinal pain, but little is known regarding the cost-effectiveness of these interventions in the U.S. Our primary objective for this project is to estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management for spinal pain using an individual patient data meta-analysis approach.

Methods/design   We will estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management using cost and clinical outcome data collected in eight randomized clinical trials performed in the U.S. Cost-effectiveness will be assessed from both societal and healthcare perspectives using QALYs, pain intensity, and disability as effectiveness measures. The eight randomized clinical trials used similar methods and included different combinations of spinal manipulation, exercise therapy, or self-management for spinal pain. They also collected similar clinical outcome, healthcare utilization, and work productivity data. A two-stage approach to individual patient data meta-analysis will be conducted.

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The Cost-Effectiveness of Chiropractic Page and the:

Chiropractic and Spinal Pain Management Page and the:

Exercise and Chiropractic Care Page

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Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

By |August 18, 2017|Cost-Effectiveness, Low Back Pain|

Health Maintenance Care in Work-Related Low Back Pain
and Its Association With Disability Recurrence

The Chiro.Org Blog


SOURCE:   J Occupat Enviro Med 2011 (Apr); 53 (4): 396–404

Manuel Cifuentes, MD, PhD,
Joanna Willetts, MS, and
Radoslaw Wasiak, PhD, MA, MSc

Center for Disability Research
Liberty Mutual Research Institute for Safety
University of Massachusetts Lowell
Hopkinton, Mass


This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP).   They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio (HR) for disability recurrence between 3 types of providers:

Physical Therapists (PT),
Physicians (MD), or
Chiropractors (DC)
.

The results are quite interesting:

  • For PTs: HR = 2.0
  • For MDs: HR = 1.6
  • For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor.

You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.

The authors concluded:

In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services.”

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

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Low Back Pain and Chiropractic Page
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Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

By |March 8, 2017|Chiropractic Care, Cost-Effectiveness|

Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

The Chiro.Org Blog


SOURCE:   Journal of Occupational Rehabilitation 2016 (Sep 17)

Marc-André Blanchette, Michèle Rivard, Clermont E. Dionne, Sheilah Hogg-Johnson, Ivan Steenstra

Public Health PhD Program,
School of Public Health,
University of Montreal,
Montreal, QC, Canada.


Objective   To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers.

Methods   We analyzed data from a cohort of 5,511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period.

Results   Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference).

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Early Predictors of Lumbar Spine Surgery After Occupational Back Injury

By |March 7, 2017|Chiropractic Care, Cost-Effectiveness|

Early Predictors of Lumbar Spine Surgery After Occupational Back Injury: Results From a Prospective Study of Workers in Washington State

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2013 (May 15); 38 (11): 953–964

Benjamin J. Keeney, PhD, Deborah Fulton-Kehoe, PhD, MPH, Judith A. Turner, PhD, Thomas M. Wickizer, PhD, Kwun Chuen Gary Chan, PhD, and Gary M. Franklin, MD, MPH


Department of Orthopaedics,
Geisel School of Medicine at Dartmouth College,
Lebanon, NH 03756, USA.


STUDY DESIGN:   Prospective population-based cohort study.

OBJECTIVE:   To identify early predictors of lumbar spine surgery within 3 years after occupational back injury.

SUMMARY OF BACKGROUND DATA:   Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury.

METHODS:   Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model’s ability to identify correctly workers who underwent surgery.

RESULTS:   In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery.

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This On-site Chiropractic Clinic Is Saving a Minnesota Manufacturer Big Money

By |March 6, 2017|Cost-Effectiveness|

This On-site Chiropractic Clinic Is Saving
a Minnesota Manufacturer Big Money

The Chiro.Org Blog


SOURCE:   The Star Tribune ~ Jan 1, 2017   

By Christopher Cassirer

Northwestern Health Sciences University
Bloomington, MN.


A year into the project, workers report that they are feeling better and like having health care services at their job. Statistics show that they are incurring injuries at much lower rates. They are also recovering quicker when they do get hurt.

And when it comes to the bottom line, the results have been better than Friendship Homes and Northwestern expected. For every $1 that the company has invested in the program, it is saving $8 by avoiding more-costly and less-effective treatments, spending less on insurance payments and keeping more workers on the job in the first place, which generates savings through less lost tine for workers and less overtime to compensate for absences.

As our nation struggles to find an affordable, effective future for health care, some answers may come from an experiment at a midsize employer in Montevideo, Minn.

Friendship Homes, with 180 employees, is one of the largest employers in the town of 5,400 about 130 miles west of the Twin Cities. The company builds prefabricated homes. And like many in construction and related industries, it has struggled to help its employees with back and muscle pain and other injuries caused by strain and overuse.

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A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

By |February 24, 2017|Chiropractic Care, Cost-Effectiveness|

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for
Spine Pain in the United States

The Chiro.Org Blog


SOURCE:   BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT

Simon Dagenais, O’Dane Brady, Scott Haldeman
and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.


BACKGROUND:   Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.

METHODS:   A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining:

1.   private health plans
2.   workers’ compensation (WC) plans, and
3.   clinical outcomes.

The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.

RESULTS:   The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.

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