Gedin Filip, Skeppholm Martin, Sparring Vibeke, Zethraeus Niklas
Department of Learning, Informatics, Karolinska Institute, Management and Ethics (LIME), Nobels väg 9, D3, Stockholm, 171 77, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
BMC Musculoskelet Disord. 2025 Feb 25;26(1):190. doi: 10.1186/s12891-025-08392-7.
To evaluate the effectiveness and cost-effectiveness of physiotherapy, chiropractic care, and the combination of physiotherapy and chiropractic care compared with information and advice for the treatment of patients with nonspecific chronic low-back pain (CLBP) in Sweden.
A multicentre pragmatic randomized controlled trial.
Ten primary care rehabilitation units in Sweden.
Eighty-eight participants with nonspecific CLBP.
The participants were randomly assigned to receive physiotherapy, chiropractic care, combination treatment, or information and advice.
This study measured the Oswestry Disability Index (ODI), health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), working status, and costs.
The study revealed no statistically significant differences in any of the outcome measures when physiotherapy, chiropractic care, and combination treatment with information and advice were compared (p > 0.05). The ODI changes between baseline and the 6-month follow-up ranged from 6.13 to 12.56 across the treatment groups, indicating reduced disability in all groups. Compared with the other treatment options, the combination treatment resulted in the greatest QALY gain (0.418) and lowest cost (SEK 3,081).
Compared with alternative standalone treatment options, the combination treatment strategy resulted in greater QALY gain and lower costs from a heath care perspective. Although the study did not detect statistically significant differences in outcomes or costs among the treatment options, the combination treatment showed promising potential for cost-effectiveness. Given the small sample size and low statistical power of the study, further clinical trials with fewer treatment arms and a focus on the combination group are warranted to confirm these findings. The insights gained from this study are important for informing the design and conduct of future clinical studies investigating the effectiveness, costs and cost-effectiveness of treatments for CLBP.
The study is registered in the ISRCTN registry (2017-02-20: ISRCTN15830360).
在瑞典，评估物理治疗、整脊治疗以及物理治疗与整脊治疗相结合的方法相较于信息与建议疗法，对非特异性慢性下腰痛（CLBP）患者的治疗效果及成本效益。
一项多中心实用随机对照试验。
瑞典的10个初级保健康复单元。
88名非特异性CLBP患者。
参与者被随机分配接受物理治疗、整脊治疗、联合治疗或信息与建议疗法。
本研究测量了奥斯威斯利残疾指数（ODI）、健康相关生活质量（HRQoL）、质量调整生命年（QALYs）、工作状态及成本。
比较物理治疗、整脊治疗以及联合信息与建议的治疗方法时，研究显示在任何结局指标上均无统计学显著差异（p＞0.05）。各治疗组在基线与6个月随访之间的ODI变化范围为6.13至12.56，表明所有组的残疾程度均有所降低。与其他治疗方案相比，联合治疗带来了最大的QALY增益（0.418）和最低的成本（3081瑞典克朗）。
从医疗保健角度来看，与其他单独治疗方案相比，联合治疗策略带来了更大的QALY增益和更低的成本。尽管该研究未检测到各治疗方案在结局或成本方面存在统计学显著差异，但联合治疗显示出了有前景的成本效益潜力。鉴于本研究样本量小且统计效力低，有必要开展进一步的临床试验——减少治疗组数量并聚焦联合治疗组——以证实这些发现。本研究获得的见解对于为未来调查CLBP治疗效果、成本及成本效益的临床研究的设计与实施提供信息具有重要意义。
该研究已在国际标准随机对照试验编号注册库注册（2017 - 02 - 20：ISRCTN15830360）。
