title: Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study.
abstract: In an attempt to prevent acute low-back pain from becoming a chronic disability problem, an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity. The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up. Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status. On the basis of this screening, high-risk patients were then randomly assigned to one of two groups: a functional restoration early intervention group (n = 22), or a nonintervention group (n = 48). A group of low-risk subjects (n = 54) who did not receive any early intervention was also evaluated. All these subjects were prospectively tracked at 3-month intervals starting from the date of their initial evaluation, culminating in a 12-month follow-up. During these follow-up evaluations, pain disability and socioeconomic outcomes (such as return-to-work and healthcare utilization) were assessed. Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the high-risk subjects who do not receive such early intervention. In addition, the high-risk nonintervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low-risk subjects. Cost-comparison savings data were also evaluated. These data revealed that there were greater cost savings associated with the early intervention group versus the no early intervention group. The overall results of this study clearly demonstrate the treatment- and cost-effectiveness of an early intervention program for acute low-back pain patients.
authors.affiliation: Eugene McDermott Center for Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA. robert.gatchel@utsouthwestern.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
authors.forename: Peter B
authors.initials: PB
authors.lastname: Polatin
authors.forename: Carl
authors.initials: C
authors.lastname: Noe
authors.forename: Margaret
authors.initials: M
authors.lastname: Gardea
authors.forename: Carla
authors.initials: C
authors.lastname: Pulliam
authors.forename: Judy
authors.initials: J
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000191:economics* / Q000534:rehabilitation*; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014938:Work Capacity Evaluation