Lilje Stina, van Tulder Maurits, Wykman Anders, Aboagye Emmanuel, Persson Ulf
Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institute, Alfred Nobels väg 13, 171 77 Stockholm, Sweden.
Faculty Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Ther Adv Musculoskelet Dis. 2023 Jan 31;15:1759720X221147751. doi: 10.1177/1759720X221147751. eCollection 2023.
Physiotherapy is usually the first line of treatment for musculoskeletal disorders. If pain persists, an appointment with an orthopaedic surgeon is indicated, but many disorders for which patients are placed on orthopaedic waiting lists cannot be treated in an orthopaedic clinic. Specialised manual therapy, although not mainstream, can be an effective alternative to orthopaedic care, although its cost-effectiveness beyond 12 months is unknown.
To perform an 8-year follow-up of the quality of life and costs of specialised manual therapy versus standard orthopaedic care for working-age patients with common nonsurgical musculoskeletal disorders referred to orthopaedic surgeons and to develop a health economic model.
Cost-effectiveness study using Markov modelling.
The index group of a previously published pragmatic randomised controlled trial received a maximum of five treatment sessions of specialised manual therapy, while the control group received orthopaedic 'care as usual'. At 3, 6, 12 and 96 months, Health-Related Quality of Life and costs were measured with Short Form Health Survey 36, Short Form Health Survey 6D and Diagnostic Related Groups. An incremental cost-effectiveness ratio was calculated, a Markov model was developed and a sensitivity analysis was performed.
Overall, 95% ( = 75) of the participants completed the 8-year follow-up. Recovery rates during the first 3 months ('per protocol') in the index and control group were 69% and 58%, respectively. The index group had 0.159 more gains in quality-adjusted life years and cost 40,270 SEK (€4027) less per patient over 8 years. The sensitivity analysis results were consistent with the main results.
Specialised manual therapy dominated standard care after 8 years. The results of this small but very first study are promising; therefore, further exploration within other health care professions, clinics and/or countries is required. Our study raises questions about the triaging of orthopaedic outpatients, cost-effectiveness and resource allocation.
Not applicable per the information provided by ClinicalTrials.gov.
Specialised manual therapy is more cost-effective than 'care as usual' for working-age patients referred to an orthopaedist. This study provides an 8-year follow-up of the cost effects and quality of life of a previously published trial. The standard care for musculoskeletal pain consists of exercises with a physiotherapist in primary care. If the pain persists, a referral to an orthopaedic clinic is often made. Many of these referrals are inappropriate because they concern pain from muscles and joints that do not benefit from surgery or the resources available in an orthopaedic clinic. There is a gap in competence and treatment between primary and specialised care that is costly, time- and resource-consuming and causes prolonged patient suffering. Although specialised manual therapy (MT) is effective, its use is not mainstream. Costs and effects after more than 12 months of treatment that may shorten waiting lists have never been evaluated. Quality of life and costs were compared in 75 patients with nonsurgical disorders referred to orthopaedic surgeons at 8 years after treatment with specialised MT or standard orthopaedic care. A health economics model for the probability of recovery was also developed and tested. Compared with the control group, the study participants treated with specialised MT had a better quality of life, required fewer health care interventions, underwent less surgery, incurred significantly lower costs and demonstrated an increased probability of recovery. It seems probable that using specialised MT for an old, well-known structural problem may yield better treatment effects at a significantly lower cost. Our study findings suggest that policy recommendations should focus on costs and effects rather than resource utilisation alone. The study is small and requires expansion using its economic health model.
物理治疗通常是肌肉骨骼疾病的一线治疗方法。如果疼痛持续存在，则需要预约骨科医生，但许多患者在骨科等待名单上的疾病无法在骨科诊所得到治疗。专业手法治疗虽然不是主流治疗方法，但可以作为骨科护理的有效替代方法，不过其超过12个月的成本效益尚不清楚。
对转介给骨科医生的患有常见非手术性肌肉骨骼疾病的工作年龄患者，进行为期8年的专业手法治疗与标准骨科护理的生活质量和成本随访，并建立健康经济模型。
使用马尔可夫模型进行成本效益研究。
一项先前发表的实用随机对照试验的指标组接受了最多5次专业手法治疗，而对照组接受常规骨科“护理”。在3、6、12和96个月时，使用简短健康调查问卷36、简短健康调查问卷6D和诊断相关分组来测量健康相关生活质量和成本。计算增量成本效益比，建立马尔可夫模型并进行敏感性分析。
总体而言，95%（n = 75）的参与者完成了8年的随访。指标组和对照组在前3个月（“符合方案”）的恢复率分别为69%和58%。指标组在质量调整生命年方面多获得0.159个单位，且每位患者在8年期间的成本降低了40270瑞典克朗（4027欧元）。敏感性分析结果与主要结果一致。
经过8年，专业手法治疗优于标准护理。这项规模虽小但却是首次进行的研究结果很有前景；因此，需要在其他医疗保健专业、诊所和/或国家进行进一步探索。我们的研究提出了关于骨科门诊患者分诊、成本效益和资源分配的问题。
根据ClinicalTrials.gov提供的信息，不适用。
对于转介给骨科医生的工作年龄患者，专业手法治疗比“常规护理”更具成本效益。本研究对先前发表的一项试验的成本效果和生活质量进行了8年的随访。肌肉骨骼疼痛的标准护理包括在初级保健中与物理治疗师一起进行锻炼。如果疼痛持续存在，通常会转介到骨科诊所。许多此类转介并不合适，因为它们涉及的肌肉和关节疼痛无法从手术或骨科诊所的现有资源中受益。初级保健和专科护理之间在能力和治疗方面存在差距，这既昂贵又耗费时间和资源，还会导致患者长期受苦。虽然专业手法治疗（MT）有效，但其应用并不主流。超过12个月治疗的成本和效果（这可能会缩短等待名单）从未得到评估。对75例接受专业MT或标准骨科护理治疗的非手术疾病患者在治疗8年后的生活质量和成本进行了比较。还建立并测试了一个关于恢复概率的健康经济模型。与对照组相比，接受专业MT治疗的研究参与者生活质量更好，所需医疗保健干预更少，手术更少，成本显著更低，且恢复概率增加。对于一个古老且众所周知的结构性问题，使用专业MT似乎可能以显著更低的成本产生更好的治疗效果。我们的研究结果表明，政策建议应侧重于成本和效果，而不仅仅是资源利用。该研究规模较小，需要使用其健康经济模型进行扩展。
