Journal of Manipulative and Physiological Therapeutics
Volume 28, Issue 8 , Pages 555-563 , October 2005

Cost-Effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain

  • Mitchell Haas, DC

      Affiliations

    • Professor and Dean of Research, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
    • Corresponding Author InformationSubmit requests for reprints to: Mitchell Haas, DC, MA, Center for Outcomes Studies, Western States Chiropractic College, 2900 NE 132nd Avenue, Portland, OR 97230.
  • ,
  • Rajiv Sharma, PhD

      Affiliations

    • Assistant Professor, Department of Economics, Portland State University, Portland, Ore
  • ,
  • Miron Stano, PhD

      Affiliations

    • Professor, Department of Economics, School of Business Administration, Oakland University, Rochester, Mich

Received 24 May 2005 ,Revised 7 July 2005

References 

  1. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004;29:79–86
  2. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22:263–271
  3. Rossignol M, Lortie M, Ledoux E. Comparison of spinal health indicators in preducting spinal status in a 1-year longitudinal study. Spine. 1993;18:54–60
  4. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246–252
  5. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569–1575
  6. Druss BG, Rosenheck RA. Association between use of unconventional therapies and conventional medical services. JAMA. 1999;282:651–656
  7. Stano M. The chiropractic services market: a literature review. Ad Health Econ Health Serv Res. 1992;13:191–204
  8. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871–881
  9. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulative therapy for low back and neck pain: a systematic review and best evidence synthesis. Spine J. 2004;4:335–356
  10. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003;138:871–881
  11. Giles LGF, Muller R. Chronic spinal pain. A randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine. 2003;28:1490–1503
  12. Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, et al. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract. 2003;20:662–669
  13. Grunnesjo MI, Bogefeldt JP, Svardsudd KF, Blomberg SIE. A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain. J Manipulative Physiol Ther. 2004;27:431–441
  14. UK BEAM Trial Team . United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004;329:1377–1381
  15. Haas M, Goldberg B, Aickin M, Ganger B, Attwood M. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther. 2004;27:160–169
  16. Mosley CD, Cohen HG, Arnold RM. Cost-effectiveness of chiropractic care in a managed care setting. Am J Manag Care. 1996;2:280–282
  17. Stano M, Smith M. Chiropractic and medical costs of low back care. Med Care. 1996;34:191–204
  18. Smith M, Stano M. Costs and recurrences of chiropractic and medical episodes of low-back care. J Manipulative Physiol Ther. 1997;20:5–12
  19. Shekelle PG, Markovich M, Louie R. Comparing the costs between provider types of episodes of back pain care. Spine. 1995;20:221–227
  20. Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. N Engl J Med. 1995;333:913–917
  21. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339:1021–1029
  22. Baldwin ML, Cote P, Frank JW, Johnson WG. Cost-effectiveness studies of medical and chiropractic care for occupational low back pain: a critical review of the literature. Spine J. 2001;1:138–147
  23. Solomon DH, Bates DW, Panush RS, Katz JN. Costs, outcomes, and patient satisfaction by provider type for patients with rheumatic and musculoskeletal conditions: a critical review of the literature and proposed methodologic standards. Ann Intern Med. 1997;127:52–60
  24. Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, DiNubile NA. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Arch Intern Med. 2004;164:1985–1992
  25. UK BEAM Trial Team . United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ. 2004;329:1381–1385
  26. Skargren EI, Oberg BE, Carlsson PG, Gade M. Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Spine. 1997;22:2167–2177
  27. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Spine. 1998;23:1875–1884
  28. Stano M, Haas M, Goldberg B, Traub P, Nyiendo J. Chiropractic and medical care costs of low back care: results from a practice-based observational study. Am J Manag Care. 2002;8:802–809
  29. Nyiendo J, Haas M, Goldberg B, Sexton G. Patient characteristics and physicians' practice activities for chronic low back pain patients: a practice-based study of primary care and chiropractic physicians. J Manipulative Physiol Ther. 2001;24:92–100
  30. Sharma R, Haas M, Stano M. Patient attitudes, insurance, and other determinants of self-referral to medical and chiropractic physicians. Am J Public Health. 2003;93:2111–2117
  31. Torrance GW. Preferences for health outcomes and cost-utility analysis. Am J Manag Care. 1997;3:S8–S20
  32. Mandelblatt JS, Fryback DG, Weinstein MC, Russel LB, Gold MR, Hadorn DC. Assessing the effectiveness of health interventions. In:  Gold MR,  Siegel JE,  Russell LB,  Weinstein MC editor. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996;p. 135–175
  33. Mandelblatt JS, Fryback DG, Weinstein MC, Russel LB, Gold MR. Assessing the effectiveness of health interventions for cost-effectiveness analysis. J Gen Intern Med. 1997;12:551–558
  34. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27:117–126
  35. Hudson-Cook N, Tomes-Nicholsonm K, Breen A. A revised Oswestry Disability Questionnaire. In:  Roland MO,  Jenner JR editor. Back pain: new approaches to rehabilitation and education. New York: Manchester University Press; 1989;p. 187–204
  36. Triano JJ, McGregor M, Cramer GD, Emde DL. A comparison of outcome measures for use with back pain patients; results of a feasibility study. J Manipulative Physiol Ther. 1993;16:67–73
  37. Bolton JE, Fish RG. Responsiveness of the revised Oswestry Disability Questionnaire. Eur J Chiropr. 1997;45:9–14
  38. Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233
  39. Luo X, George ML, Kakouras I, Edwards CL, Pietrobon R, Richardson W, et al. Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine. 2003;28:1739–1745
  40. Smith GR, Burnam MA, Burns BJ, Cleary PD, Rost KM. User's manual: depression TyPE specification. St. Paul (Minn): InterStudy; 1990;
  41. User's manual: low back pain TyPE specification. 1st ed. Bloomington (Minn): Quality Quest; 1989;
  42. Philips HC, Grant L, Berkowitz J. The prevention of chronic pain and disability: a preliminary investigation. Behav Res Ther. 1991;29:443–450
  43. Burack RC, Simon MS, Stano M, George J, Coombs J. Follow-up among women with an abnormal mammogram in an HMO: is it complete, timely, and efficient?. Am J Manag Care. 2000;6:1102–1113
  44. Mushinski M. Treatment of back pain: outpatient service charges, 1993. Stat Bull Metrop Insur Co. 1995;76:32–39
  45. Roland M, Morris R. A study of the natural history of low-back pain part II: development of guidelines for trials of treatment in primary care. Spine. 1983;8:145–150
  46. SAS Version 8.2. Cary (NC): The SAS Institute; 2001;
  47. Nyiendo J, Haas M, Goldberg B, Sexton G. Pain, disability and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians. J Manipulative Physiol Ther. 2001;24:433–439
  48. Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V. It's the prices, stupid: why the United States is so different from other countries. Health Aff (Millwood). 2003;22:89–105
  49. Reinhardt UE, Hussey PS, Anderson GF. US health care spending in an international context. Health Aff (Millwood). 2004;23:10–25
  50. Kominski GF, Heslin KC, Morgenstern H, Hurwitz EL, Harber PI. Economic evaluation of four treatments for low-back pain: results from a randomized controlled trial. Med Care. 2005;43:428–435
  51. Hornbrook MC, Hurtado AV, Johnson RE. Health care episodes: definition, measurement and use. Med Care Rev. 1985;42:163–218
  52. Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996;312:1215–1218
  53. Lamm LC, Pfannenschmidt K. Chiropractic scope of practice: what the law allows: update 1999. J Neuromusculoskel Syst. 1999;7:102–106

 Sources of support: This study was supported by the Health Resources and Services Administration, Department of Health and Human Services, Rockland, Md (grant no. R18 AH10002) and by a competitive challenge grant from the Foundation for Chiropractic Education and Research, Norwalk, Iowa (grant no. 940502) with funds donated to the foundation by the National Chiropractic Mutual Insurance Corporation, Des Moines, Iowa.

PII: S0161-4754(05)00227-7

doi: 10.1016/j.jmpt.2005.08.006

Journal of Manipulative and Physiological Therapeutics
Volume 28, Issue 8 , Pages 555-563 , October 2005