title: Acute low back pain and economics of therapy: the iterative loop approach.
abstract: We use the measurement iterative loop as a conceptual framework to examine the economics of common therapies for acute non-specific low back pain. The measurement iterative loop systematically assesses the interlocking facets of an illness from the community health perspective, including quantifying burden of illness, etiology, assessment of therapeutic effectiveness, and economic evaluation of therapies. The iterative loop reveals that: (1) burden of illness, although known to be substantial, is so far inaccurately measured, (2) little is known about such factors as provider and patient compliance; and (3) the economics of therapy can guide us in this time of clinical uncertainty when no therapy appears clearly superior. For therapies with at least some support from randomized controlled trials, bedrest appears to be economically superior. Besides burden of illness, compliance, and current therapies, future research should address such "therapeutic" options as early return to work and patient self-management.
authors.affiliation: Department of Medicine, University of Texas Health Science Center, San Antonio.
authors.forename: V A
authors.initials: VA
authors.lastname: Lawrence
authors.forename: P
authors.initials: P
authors.lastname: Tugwell
authors.forename: A
authors.initials: A
authors.lastname: Gafni
authors.forename: W
authors.initials: W
authors.lastname: Kosuwon
authors.forename: W O
authors.initials: WO
authors.lastname: Spitzer
mesh_terms: D000208:Acute Disease; D001416:Back Pain / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D005102:Health Expenditures; D006801:Humans; D007349:Insurance, Health, Reimbursement; D010349:Patient Compliance; D026741:Physical Therapy Modalities / Q000191:economics* / Q000379:methods; D016032:Randomized Controlled Trials as Topic