Determinants for receiving acupuncture for LBP and associated treatments: a prospective cohort study.
BACKGROUND
Acupuncture is a frequently used but controversial adjunct to the treatment of chronic low back pain (LBP). Acupuncture is now considered to be effective for chronic LBP and health care systems are pressured to make a decision whether or not acupuncture should be covered. It has been suggested that providing such services might reduce the use of other health care services. Therefore, we explored factors associated with acupuncture treatment for LBP and the relation of acupuncture with other health care services.


METHODS
This is a post hoc analysis of a longitudinal prospective cohort study. General practitioners (GPs) recruited consecutive adult patients with LBP. Data on physical function, subjective mood and utilization of health care services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months.


RESULTS
A total of 179 (13 %) out of 1,345 patients received acupuncture treatment. The majority of those (59 %) had chronic LBP. Women and elderly patients were more likely to be given acupuncture. Additional determinants of acupuncture therapy were low functional capacity and chronicity of pain. Chronic (vs. acute) back pain OR 1.6 (CL 1.4-2.9) was the only significant disease-related factor associated with the treatment. The strongest predictors for receiving acupuncture were consultation with a GP who offers acupuncture OR 3.5 (CL 2.9-4.1) and consultation with a specialist OR 2.1 (CL 1.9-2.3). After adjustment for patient characteristics, acupuncture remained associated with higher consultation rates and an increased use of other health care services like physiotherapy.


CONCLUSIONS
Receiving acupuncture for LBP depends mostly on the availability of the treatment. It is associated with increased use of other health services even after adjustment for patient characteristics. In our study, we found that receiving acupuncture does not offset the use of other health care resources. A significant proportion of patients who received did not meet the so far only known selection criterion (chonicity). Acupuncture therapy might be a reflection of helplessness in both patients and health care providers.
Chenot
Jean-François
JF
Dpt, of General Practice, University of Göttingen, Humboldtallee 38, 37073 Goettingen, Germany. jchenot@gwdg.de
Becker
Annette
A
Leonhardt
Corinna
C
Keller
Stefan
S
Donner-Banzhoff
Norbert
N
Baum
Erika
E
Pfingsten
Michael
M
Hildebrandt
Jan
J
Kochen
Michael M
MM
Basler
Heinz-Dieter
HD
D015670:Acupuncture Therapy / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003376:Counseling; D003657:Decision Making; D003937:Diagnosis, Differential; D005194:Family Practice / Q000592:standards*; D005260:Female; D005858:Germany; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008161:Lumbosacral Region / Q000503:physiopathology; D008297:Male; D008332:Management Quality Circles; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D011446:Prospective Studies