Department of Health Sciences, Faculty of Science, The Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Van Der Boechorststraat 3, 1081 BT, Amsterdam, The Netherlands.
Capilano University, 2055 Purcell Way, North Vancouver, BC, V7J 3H5, Canada.
Chiropr Man Therap. 2024 Nov 6;32(1):31. doi: 10.1186/s12998-024-00553-0.
To describe the societal costs during one year of follow-up among older adults seeking chiropractic care due to a new episode of low back pain (LBP), and to determine what factors predict high societal costs in this population.
Prospective cohort study, within chiropractic private practices (n = 38) in the Netherlands. 223 people ≥ 55 years of age with a new episode of LBP seeking chiropractic care participated. The primary outcome was total societal costs. High societal costs were defined as patients with costs in the top 20th percentile. The final prediction models were obtained using forward selection. Results were presented for the total population and stratified for retirement status. The model's prognostic accuracy (Hosmer-Lemeshow X, Nagelkerke's R) and discriminative ability [area under the receiver operating curve (AUC)] were assessed, and the models were internally validated using bootstrapping.
The mean total annual societal cost per patient was €5297 [95% confidence interval (CI): 4191-6403]. The biggest cost driver was presenteeism (65% of total costs), and costs were higher among non-retired participants (€7759; 95% CI 6047-9470) than retired participants (€1892; 95% CI 1088-2695). In the total population, younger age [odds ratio (OR): 0.87 for each additional year; 95% CI 0.80-0.95], being male instead of female (OR 2.96; 95% CI 1.19-7.44), less alcohol intake (OR 0.49; 95% CI 0.20-1.19), working instead of retirement (OR 9.37; 95% CI 1.83-48.04), and more disability at baseline (OR 1.08; 95% CI 1.00-1.16) were found to be predictive of high societal costs. Working was found to be the strongest predictor for high societal costs. After internal validation, the model's fit was good, it's explained variance was moderate (28%) and their AUCs could be interpreted as moderate (0.85). For non-pensioners, the same predictive factors were identified as for the entire population. The costs for the retired participants showed too little variation to be able to predict high costs.
This study estimated the mean total annual societal cost of older adults seeking chiropractic care due to a new episode of LBP at €5297 (95% CI 4191-6403).These costs were mainly due to high levels of presenteeism, and extensively differed based upon work status.
描述在荷兰私人整脊诊所寻求整脊治疗的老年患者因新发腰痛（LBP）进行一年随访的社会成本，并确定哪些因素可以预测该人群的高社会成本。
前瞻性队列研究，在荷兰的私人整脊诊所（n=38）内进行。223 名年龄≥55 岁且新发腰痛（LBP）的患者接受了整脊治疗。主要结局是总社会成本。高社会成本定义为成本处于前 20%的患者。使用向前选择获得最终预测模型。为整个人群和按退休状态分层呈现结果。评估模型的预测准确性（Hosmer-Lemeshow X、Nagelkerke 的 R）和判别能力[受试者工作特征曲线下面积（AUC）]，并使用自举法对模型进行内部验证。
每位患者的平均年总社会成本为 5297 欧元（95%置信区间：4191-6403）。最大的成本驱动因素是缺勤（占总成本的 65%），非退休参与者（€7759；95%置信区间 6047-9470）的成本高于退休参与者（€1892；95%置信区间 1088-2695）。在整个人群中，年龄较小（每增加一年的优势比[OR]：0.87；95%置信区间 0.80-0.95）、男性而非女性（OR 2.96；95%置信区间 1.19-7.44）、饮酒量较少（OR 0.49；95%置信区间 0.20-1.19）、工作而非退休（OR 9.37；95%置信区间 1.83-48.04）和基线时残疾程度较高（OR 1.08；95%置信区间 1.00-1.16）与高社会成本相关。工作被发现是高社会成本的最强预测因素。内部验证后，模型拟合良好，解释方差适度（28%），AUC 可解释为适度（0.85）。对于非养老金领取者，与整个人群相同的预测因素被确定。退休参与者的成本变化太小，无法预测高成本。
本研究估计在荷兰私人整脊诊所寻求整脊治疗的老年患者因新发腰痛（LBP）导致的年总社会成本为 5297 欧元（95%置信区间 4191-6403）。这些成本主要是由于缺勤率高，并且根据工作状态有很大差异。
