Addition of choice of complementary therapies to usual care for acute low back pain: A randomized controlled trial

David M. Eisenberg, Diana E. Post, Roger B. Davis, Maureen T. Connelly, Anna T.R. Legedza, Andrea L. Hrbek, Lisa A. Prosser, Julie E. Buring, Thomas S. Inui, Daniel C. Cherkin

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

STUDY DESIGN. A randomized controlled trial. OBJECTIVE. To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA. Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies. METHODS. A total of 444 patients with acute LBP (<21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization. RESULTS. After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of $244 per patient. This consisted of a $99 reduction in the average cost to the insurer for medical care but an additional cost of $343, for an average of 6.0 complementary and alternative medicine treatments per patient. CONCLUSIONS. A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.

Original languageEnglish (US)
Pages (from-to)151-158
Number of pages8
JournalSpine
Volume32
Issue number2
DOIs
StatePublished - Jan 1 2007

Fingerprint

Complementary Therapies
Low Back Pain
Randomized Controlled Trials
Costs and Cost Analysis
Health Care Costs
Acupuncture Therapy
Chiropractic
Insurance Carriers
Massage
Back Pain
Random Allocation
Patient Satisfaction
Chronic Pain
Cost-Benefit Analysis
Patient Care

Keywords

  • Acupuncture
  • Acute low back pain
  • Chiropractic
  • Choice
  • Complementary therapies
  • Massage therapy

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Eisenberg, D. M., Post, D. E., Davis, R. B., Connelly, M. T., Legedza, A. T. R., Hrbek, A. L., ... Cherkin, D. C. (2007). Addition of choice of complementary therapies to usual care for acute low back pain: A randomized controlled trial. Spine, 32(2), 151-158. https://doi.org/10.1097/01.brs.0000252697.07214.65

Addition of choice of complementary therapies to usual care for acute low back pain : A randomized controlled trial. / Eisenberg, David M.; Post, Diana E.; Davis, Roger B.; Connelly, Maureen T.; Legedza, Anna T.R.; Hrbek, Andrea L.; Prosser, Lisa A.; Buring, Julie E.; Inui, Thomas S.; Cherkin, Daniel C.

In: Spine, Vol. 32, No. 2, 01.01.2007, p. 151-158.

Research output: Contribution to journalArticle

Eisenberg, DM, Post, DE, Davis, RB, Connelly, MT, Legedza, ATR, Hrbek, AL, Prosser, LA, Buring, JE, Inui, TS & Cherkin, DC 2007, 'Addition of choice of complementary therapies to usual care for acute low back pain: A randomized controlled trial', Spine, vol. 32, no. 2, pp. 151-158. https://doi.org/10.1097/01.brs.0000252697.07214.65
Eisenberg, David M. ; Post, Diana E. ; Davis, Roger B. ; Connelly, Maureen T. ; Legedza, Anna T.R. ; Hrbek, Andrea L. ; Prosser, Lisa A. ; Buring, Julie E. ; Inui, Thomas S. ; Cherkin, Daniel C. / Addition of choice of complementary therapies to usual care for acute low back pain : A randomized controlled trial. In: Spine. 2007 ; Vol. 32, No. 2. pp. 151-158.
@article{7bddfa47da394bfbbaec2b8656b60b3e,
title = "Addition of choice of complementary therapies to usual care for acute low back pain: A randomized controlled trial",
abstract = "STUDY DESIGN. A randomized controlled trial. OBJECTIVE. To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA. Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies. METHODS. A total of 444 patients with acute LBP (<21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization. RESULTS. After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of $244 per patient. This consisted of a $99 reduction in the average cost to the insurer for medical care but an additional cost of $343, for an average of 6.0 complementary and alternative medicine treatments per patient. CONCLUSIONS. A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.",
keywords = "Acupuncture, Acute low back pain, Chiropractic, Choice, Complementary therapies, Massage therapy",
author = "Eisenberg, {David M.} and Post, {Diana E.} and Davis, {Roger B.} and Connelly, {Maureen T.} and Legedza, {Anna T.R.} and Hrbek, {Andrea L.} and Prosser, {Lisa A.} and Buring, {Julie E.} and Inui, {Thomas S.} and Cherkin, {Daniel C.}",
year = "2007",
month = "1",
day = "1",
doi = "10.1097/01.brs.0000252697.07214.65",
language = "English (US)",
volume = "32",
pages = "151--158",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Addition of choice of complementary therapies to usual care for acute low back pain

T2 - A randomized controlled trial

AU - Eisenberg, David M.

AU - Post, Diana E.

AU - Davis, Roger B.

AU - Connelly, Maureen T.

AU - Legedza, Anna T.R.

AU - Hrbek, Andrea L.

AU - Prosser, Lisa A.

AU - Buring, Julie E.

AU - Inui, Thomas S.

AU - Cherkin, Daniel C.

PY - 2007/1/1

Y1 - 2007/1/1

N2 - STUDY DESIGN. A randomized controlled trial. OBJECTIVE. To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA. Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies. METHODS. A total of 444 patients with acute LBP (<21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization. RESULTS. After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of $244 per patient. This consisted of a $99 reduction in the average cost to the insurer for medical care but an additional cost of $343, for an average of 6.0 complementary and alternative medicine treatments per patient. CONCLUSIONS. A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.

AB - STUDY DESIGN. A randomized controlled trial. OBJECTIVE. To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA. Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies. METHODS. A total of 444 patients with acute LBP (<21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization. RESULTS. After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of $244 per patient. This consisted of a $99 reduction in the average cost to the insurer for medical care but an additional cost of $343, for an average of 6.0 complementary and alternative medicine treatments per patient. CONCLUSIONS. A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.

KW - Acupuncture

KW - Acute low back pain

KW - Chiropractic

KW - Choice

KW - Complementary therapies

KW - Massage therapy

UR - http://www.scopus.com/inward/record.url?scp=33846205958&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846205958&partnerID=8YFLogxK

U2 - 10.1097/01.brs.0000252697.07214.65

DO - 10.1097/01.brs.0000252697.07214.65

M3 - Article

C2 - 17224808

AN - SCOPUS:33846205958

VL - 32

SP - 151

EP - 158

JO - Spine

JF - Spine

SN - 0362-2436

IS - 2

ER -