Department of Osteosciences, Neuromusculoskeletal Institute, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
Department of Physical Medicine and Rehabilitation, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
J Osteopath Med. 2021 Apr 15;121(7):635-642. doi: 10.1515/jom-2020-0238.
Chronic low back pain (cLBP) is the second leading cause of disability in the United States, with significant physical and financial implications. Development of a multifaceted treatment plan that is cost effective and optimizes patients' ability to function on a daily basis is critical. To date, there have been no published prospective studies comparing the cost of osteopathic manipulative treatment to that of standard care for patients with cLBP.
To contrast the cost for standard of care treatment (SCT) for cLBP with standard of care plus osteopathic manipulative treatment (SCT + OMT).
This prospective, observational study was conducted over the course of 4 months with two groups of patients with a diagnosis of cLBP. Once consent was obtained, patients were assigned to the SCT or the SCT + OMT group based on the specialty practice of their physician. At enrollment and after 4 months of treatment, all patients in both groups completed two questionnaires: the 11 point pain intensity numerical scale (PI-NRS) and the Roland Morris Disability Questionnaire (RMDQ). Cost data was collected from the electronic medical record of each patient enrolled in the study. Chi-square () tests for independence using Yates' correction for continuity were performed to compare the results for each group.
There was a total of 146 patients: 71 (48.6%) in the SCT + OMT group and 75 (51.4%) in the SCT group. The results showed no significant differences between the mean total costs for the SCT + OMT ($831.48 ± $553.59) and SCT ($997.90 ± $1,053.22) groups. However, the utilization of interventional therapies (2; 2.8%) and radiology (4; 5.6%) services were significantly less for the SCT + OMT group than the utilization of interventional (31; 41.3%) and radiology (17; 22.7%) therapies were for the SCT group (p<0.001). Additionally, the patients in the SCT + OMT group were prescribed fewer opioid medications (15; 21.1) than the SCT (37; 49.3%) patients (p.001). Patients in the SCT group were approximately 14.7 times more likely to have received interventional therapies than patients in the SCT + OMT group. Likewise, the patients in the SCT group were approximately four times more likely to have received radiological services. Paired tests comparing the mean pre- and 4 month self reported pain severity scores on the RMDQ for 68 SCT + OMT patients (9.91 ± 5.88 vs. 6.40 ± 5.24) and 66 SCT patients (11.44 ± 6.10 vs. 8.52 ± 6.14) found highly significant decreases in pain for both group (<0.001).
The mean total costs for the SCT and SCT + OMT patients were statistically comparable across 4 months of treatment. SCT + OMT was comparable to SCT alone in reducing pain and improving function in patients with chronic low back pain; however, there was less utilization of opioid analgesics, physical therapy, interventional therapies, radiologic, and diagnostic services for patients in the SCT + OMT group.
慢性下腰痛（cLBP）是美国导致残疾的第二大原因，对身体和经济都有重大影响。制定一个成本效益高且能优化患者日常功能的多方面治疗计划至关重要。迄今为止，还没有发表过比较骨疗按摩治疗成本与慢性下腰痛标准护理成本的前瞻性研究。
比较慢性下腰痛标准护理治疗（SCT）与标准护理加骨疗按摩治疗（SCT+OMT）的成本。
这是一项为期 4 个月的前瞻性观察性研究，有两组慢性下腰痛患者。一旦获得同意，根据患者医生的专业实践，将患者分配到 SCT 或 SCT+OMT 组。在入组时和治疗 4 个月后，两组所有患者均完成了两个问卷：11 点疼痛强度数字评分（PI-NRS）和 Roland Morris 残疾问卷（RMDQ）。从每位入组患者的电子病历中收集成本数据。使用 Yates 连续性校正的卡方（）检验进行独立性检验，以比较每组的结果。
共有 146 名患者：71 名（48.6%）在 SCT+OMT 组，75 名（51.4%）在 SCT 组。结果显示，SCT+OMT 组（831.48±553.59 美元）和 SCT 组（997.90±1053.22 美元）的总治疗费用无显著差异。然而，SCT+OMT 组介入治疗（2 例；2.8%）和放射学（4 例；5.6%）服务的使用率明显低于 SCT 组（介入治疗 31 例；41.3%，放射学 17 例；22.7%）（p<0.001）。此外，SCT+OMT 组患者开的阿片类药物（15；21.1）比 SCT 组（37；49.3）患者少（p.001）。SCT 组患者接受介入治疗的可能性约是 SCT+OMT 组患者的 14.7 倍。同样，SCT 组患者接受放射学服务的可能性大约是 SCT+OMT 组患者的四倍。对 SCT+OMT 组 68 名患者（9.91±5.88 vs. 6.40±5.24）和 SCT 组 66 名患者（11.44±6.10 vs. 8.52±6.14）的 RMDQ 自我报告疼痛严重程度评分进行配对检验，发现两组患者的疼痛均有显著降低（<0.001）。
SCT 和 SCT+OMT 患者的平均总治疗费用在 4 个月的治疗期间具有统计学可比性。SCT+OMT 在减轻慢性下腰痛患者的疼痛和改善功能方面与 SCT 单独治疗相当；然而，SCT+OMT 组患者的阿片类镇痛药、物理治疗、介入治疗、放射学和诊断服务的使用率较低。
