Quality of life and cost of care of back pain patients in Finnish general practice.
METHODS
A cohort of 114 primary care patients were studied for 1 year before and 1 year after a randomized clinical trial.


OBJECTIVE
To explore the therapy use, societal costs, and quality of life of patients with prolonged back pain. To compare the effects of physiotherapy, bone setting, and light exercise therapy on these measures.


BACKGROUND
Analyses of back pain have mostly focused on the minority of patients who cause high costs and a heavy burden on national economies. The majority with low costs have aroused less interest. The patient's choice of therapy, especially alternative medicine, has seldom been evaluated despite the increasing popularity of alternative therapies.


METHODS
Data were collected from the Social Insurance Institution files, patient records, and questionnaires: the Nottingham Health Profile (NHP).


RESULTS
One year before enrollment a third of the patients had consulted primary care. Half of them had had some therapy: mainly massage, physiotherapy, naprapathy, or bone setting. One third of the direct costs were spent on complementary therapies and another third on rehabilitation. Sick leaves accounted for 55% of the total costs (US$ 1029). The mean total costs slightly increased after the randomized therapies (US$ 1306). The costs of ambulatory care, with the study therapies included, were similar, whereas physiotherapy seemed the cheapest (US$ 621) and bone setting the most expensive (US$ 2072) alternative in view of the total costs. More NHP subscales were improved by physiotherapy and bone setting than by exercise.


CONCLUSIONS
A third of the direct back pain costs were spent on complementary therapies. The use of health care services and absenteeism tended to decrease after a course of physiotherapy. Physiotherapy and bone setting seemed able to improve the quality of life of patients with prolonged back pain.
Hemmilä
Heikki M
HM
Folk Medicine Centre, Kaustinen, Finland. heikki.hemmila@pp.fimnet.fi
D000328:Adult; D001416:Back Pain / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D017281:Cost of Illness; D005081:Exercise Therapy / Q000191:economics / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008405:Massage / Q000191:economics / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D010147:Pain Measurement; D026761:Physical Therapy Specialty / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies