Rantonen J, Karppinen J, Vehtari A, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S
Finnish Institute of Occupational Health (FIOH), P.B. 40, 00251, Helsinki, Finland.
Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
BMC Public Health. 2016 Apr 12;16:316. doi: 10.1186/s12889-016-2974-4.
Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP), but effectiveness and cost-effectiveness (CE) of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH) setting in a quasi-experimental study.
A cohort of employees (N = 312, aged <57) with non-specific, mild LBP (Visual Analogue Scale between 10-34 mm) was selected from the respondents of an employee survey (N = 2480; response rate 71 %). A random sample, representing the natural course of LBP (NC, N = 83; no intervention), was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded) into a randomised controlled study with two 1:1 allocated parallel intervention arms ("Booklet", N = 92; "Combined", N = 89). All participants received the "Back Book" patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI), LBP, health care (HC) utilisation, and all-cause sickness absence (SA) were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values.
Compared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions.
Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care system.
ClinicalTrials.gov NCT00908102.
有证据表明，针对下背部的特定患者信息对亚急性下背痛（LBP）有效，但在早期症状阶段该信息的有效性和成本效益（CE）尚不清楚。我们在一项准实验研究中评估了职业健康（OH）环境下患者信息对轻度LBP的有效性和CE。
从一项员工调查（N = 2480；回复率71%）的受访者中选取一组患有非特异性轻度LBP（视觉模拟量表评分在10 - 34毫米之间）的员工（N = 312，年龄<57岁）。抽取一个代表LBP自然病程（NC，N = 83；无干预）的随机样本作为对照组。其余员工被邀请（181人纳入，47人拒绝，1人排除）参加一项随机对照研究，该研究有两个1:1分配的平行干预组（“手册组”，N = 92；“组合组”，N = 89）。所有参与者都收到了“背部手册”患者信息手册，组合组还对手册进行了个人口头讲解。在两年时评估身体损伤（PHI）、LBP、医疗保健（HC）利用情况和全因病假（SA）。通过使用基线后一年、两年的直接HC成本分析干预措施对SA天数的CE。对缺失值采用多重填补法。
与NC组相比，手册组每年降低HC成本196欧元，减少SA 3.5天。在81%的自抽样案例中，手册组在SA方面既节省成本又有效。与NC组相比，组合组的相应数字分别为107欧元、0.4天和54%。两种干预措施下PHI均有所下降。
与轻度LBP的自然病程相比，仅手册信息就具有成本效益。组合信息降低了HC成本。两种干预措施都减轻了身体损伤。仅手册信息对在OH环境中报告轻度LBP的员工有益，对医疗保健系统而言也节省了成本。
ClinicalTrials.gov NCT00908102。
