A Randomized Trial of Combined Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain

Niemistö, Leena; Lahtinen-Suopanki, Tiina; Rissanen, Pekka; Lindgren, Karl-August; Sarna, Seppo; Hurri, Heikki

doi:10.1097/01.brs.0000085096.62603.61

Cited by 191 publications

(164 citation statements)

References 23 publications

(21 reference statements)

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“…Six studies compared advice to another treatment [20-22, 27, 38, 46], and three compared adding another treatment to advice with advice alone [23,24,26,36]. Regardless of the comparison and the economic perspective adopted, results regarding the cost-effectiveness of advice were inconsistent across the studies (Table 2).…”

Section: Quality Of the Economic Evaluationmentioning

confidence: 77%

“…Seven studies did not state the economic perspective adopted [21, 22, 29-32, 35, 41]. An incremental costeffectiveness analysis was conducted in all but 2 of the 19 cost-effectiveness or cost-utility studies [23,24,41]. Three of the nine studies which had a follow-up period of greater than 1 year did not use discounting [23][24][25]30].…”

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

“…Regardless of the comparison and the economic perspective adopted, results regarding the cost-effectiveness of advice were inconsistent across the studies (Table 2). Four studies suggested that advice may be more cost-effective than treatments received in primary care [21,22,27] or a book on back pain care [20], but other studies reported a cost-effectiveness ratio or cost-benefit outcome which favoured adding naturopathic care [46], graded activity [26],or manipulation and stabilizing exercises [23,24] over advice alone, or physiotherapy over advice [38]. In a study comparing adding manipulation and exercises to advice alone [23,24], it is unclear why the reported cost-effectiveness ratio was positive for pain but negative for disability, given that costs were identical and the direction of benefits was the same for both outcomes.…”

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

“…These studies had almost identical design features so are referred to as ''Strong et al'' in the current paper. For two of the included studies, results of the one-and two-year follow-up were published separately [21][22][23][24]. Most studies conducted a cost-effectiveness and/or cost-utility analysis.…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

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Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Lin

Haas

Maher

et al. 2011

Deutsche Zeitschrift für Akupunktur

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Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative costeffectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were costeffective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guidelineendorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitivebehavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline.

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Section: Quality Of the Economic Evaluationmentioning

confidence: 77%

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

Section: Quality Of the Economic Evaluationmentioning

confidence: 99%

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Lin

Haas

Maher

et al. 2011

Deutsche Zeitschrift für Akupunktur

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“…Neck stabilization exercises are commonly prescribed by clinicians to protect damaged cervical structures from further injury, recurrent pain episodes, and degenerative change, as well as reduce the intensity of the pain and disability due to neck pain [26][27][28][29][30] . Neck stabilization exercises incorporate various methods s u c h a s s t r e t c h i ng , i s om e t r i c / s t a t i c or d yn a m i c strengthening, and resistance or endurance training as well as proprioceptive exercises.…”

Section: Introductionmentioning

confidence: 99%

A Multimodal Treatment Approach using Spinal Decompression via SpineMED, Flexion-Distraction Mobilization of the Cervical Spine, and Cervical Stabilization Exercises for the Treatment of Cervical Radiculopathy

Ma¹,

Kim

2011

J Phys Ther Sci

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Abstract.[Purpose] The aim of the present study was to determine whether a multimodal treatment approach using spinal decompression via SpineMED and spinal mobilization as well as cervical stabilization exercises would benefit patients with neck pain with radiculopathy.[Subjects] A total of 10 patients with cervical radiculopathy ranging in age from 19 to 46 with an average age of 35.50 years participated in this study. [Methods] Patients received treatment in 85 minute sessions, 6 days per week for the first two weeks, and 4 days per week for two additional weeks. Treatment protocol consisted of spinal decompression via SpineMED and flexion-distraction mobilization of the cervical spine as well as cervical stabilization exercises. Physical therapy modalities including superficial heat, ultrasound, and interferential current were also delivered prior to administration of SpineMED. Differences between patients' preintervention and discharge outcome measures, pain on a visual analogue scale (VAS) and neck disability index (NDI), were examined using a paired t-test.[Results] Mean measures of patients' VAS and NDI demonstrated significant improvement after being treated with 20 sessions of combined treatment. [Conclusion] Findings of the present study provide significant evidence to support the efficacy of a multimodal treatment approach using spinal decompression via SpineMED and spinal mobilization as well as cervical stabilization exercises. A multimodal approach might be an asset in the management of cervical spine disorders.

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Exercise therapy for treatment of non-specific low back pain

Hayden

Tulder

Malmivaara

et al. 2005

Cochrane Database of Systematic Reviews

631

506

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A Randomized Trial of Combined Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain

Cited by 191 publications

References 23 publications

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

A Multimodal Treatment Approach using Spinal Decompression via SpineMED, Flexion-Distraction Mobilization of the Cervical Spine, and Cervical Stabilization Exercises for the Treatment of Cervical Radiculopathy

Exercise therapy for treatment of non-specific low back pain

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