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document
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 . 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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Intervention_Physical
combined manipulation
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Intervention_Physical
stabilizing exercises
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Intervention_Physical
physician consultation
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Intervention_Control
physician consultation alone
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Intervention_Physical
combined manipulative treatment , stabilizing exercises , and physician consultation compared with
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Intervention_Control
physician consultation alone
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Intervention_Physical
manipulative treatment , exercise , and physician consultation group
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Intervention_Control
consultation
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Intervention_Physical
alone
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Intervention_Physical
manual therapy and stabilizing exercises
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Intervention_Control
Physician consultation alone
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Outcome_Pain
pain ( visual analog scale ( VAS ) ) ,
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Outcome_Physical
disability ( ODI )
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Outcome_Physical
health-related quality of life
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Outcome_Physical
15D Quality of Life Instrument
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Outcome_Other
satisfaction with care
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Outcome_Other
costs
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Outcome_Physical
self-rated outcome
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Outcome_Pain
VAS
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Outcome_Other
patient satisfaction
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Outcome_Other
cost-effective
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Participant_Condition
chronic low back pain :
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Participant_Condition
chronic low back pain ( cLBP
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Participant_Sample-size
204
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Participant_Condition
cLBP