Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month follow-up.
METHODS
A randomized, clinical trial was conducted in which patients with back/neck problems, visiting a general practitioner, were allocated to chiropractic or physiotherapy as primary management.


OBJECTIVE
To compare outcome and costs of chiropractic and physiotherapy in managing patients with low back or neck pain.


BACKGROUND
Earlier studies on the treatment of back pain by spinal manipulation have shown inconsistent results. When a "new" strategy--chiropractic--in the treatment of back pain was introduced in public health care in Sweden, there was a need to compare the effects and costs of chiropractic with the established physiotherapy.


METHODS
Three hundred twenty-three patients aged 18 to 60 years who had no contraindications to manipulation and who had not been treated within the previous month were included in the study. Treatment was carried out at the discretion of the therapist. Outcome measures were primarily changes in pain intensity and general health, both assessed with visual analog scale and Oswestry pain disability questionnaire. Direct and indirect costs were measured.


RESULTS
For patients with low back or neck pain visiting the general practitioner in primary care, both chiropractic and physiotherapy as primary treatment reduced the symptoms. No difference in outcome or direct or indirect costs between the two groups could be seen, nor in subgroups defined as duration, history, or severity.


CONCLUSIONS
The effectiveness and total costs of chiropractic or physiotherapy as primary treatment were similar to reach the same result after treatment and after 6 months.
Skargren
E I
EI
Department of Caring Sciences, Faculty of Health Sciences, Linköping University, Sweden.
Oberg
B E
BE
Carlsson
P G
PG
Gade
M
M
D000293:Adolescent; D000328:Adult; D002684:Chiropractic / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000191:economics / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000191:economics*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome