title: Cost-effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2-year follow-up.
abstract: METHODS
  A prospective, randomized controlled trial.
  
  
  OBJECTIVE
  To examine long-term effects and costs of combined manipulative treatment, stabilizing exercises, and physician consultation compared with physician consultation alone for chronic low back pain (cLBP).
  
  
  BACKGROUND
  An obvious gap exists in knowledge concerning long-term efficacy and cost-effectiveness of manipulative treatment methods.
  
  
  METHODS
  Of 204 patients with cLBP whose Oswestry Disability Index (ODI) was at least 16%, 102 were randomized into a combined manipulative treatment, exercise, and physician consultation group (i.e., a combination group), and 102 to a consultation alone group. All patients were clinically examined, informed about their back pain, and encouraged to stay active and exercise according to specific instructions based on clinical evaluation. Treatment included 4 sessions of manual therapy and stabilizing exercises aimed at correcting the lumbopelvic rhythm. Questionnaires inquired about pain (visual analog scale (VAS)), disability (ODI), health-related quality of life (15D Quality of Life Instrument), satisfaction with care, and costs.
  
  
  RESULTS
  Significant improvement occurred in both groups on every self-rated outcome measurement. Within 2 years, the combination group showed only a slightly more significant reduction in VAS (P = 0.01, analysis of variance) but clearly higher patient satisfaction (P = 0.001, Pearson chi2) as compared to the consultation group. Incremental analysis showed that for combined group compared to consultation group, a one-point change in VAS scale cost $512.
  
  
  CONCLUSIONS
  Physician consultation alone was more cost-effective for both health care use and work absenteeism, and led to equal improvement in disability and health-related quality of life. It seems obvious that encouraging information and advice are major elements for the treatment of patients with cLBP.
authors.affiliation: Orthopaedic Hospital Orton, Invalid Foundation, Helsinki, Finland. leena.niemisto@dextra.fi
authors.forename: Leena
authors.initials: L
authors.lastname: Niemistö
authors.forename: Pekka
authors.initials: P
authors.lastname: Rissanen
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Tiina
authors.initials: T
authors.lastname: Lahtinen-Suopanki
authors.forename: Karl-August
authors.initials: KA
authors.lastname: Lindgren
authors.forename: Heikki
authors.initials: H
authors.lastname: Hurri
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000503:physiopathology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000191:economics*; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome