title: Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial.
abstract: METHODS
  A randomized controlled trial.
  
  
  OBJECTIVE
  To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP).
  
  
  BACKGROUND
  Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies.
  
  
  METHODS
  A total of 444 patients with acute LBP (<21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization.
  
  
  RESULTS
  After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of 244 dollars per patient. This consisted of a 99 dollars reduction in the average cost to the insurer for medical care but an additional cost of 343 dollars, for an average of 6.0 complementary and alternative medicine treatments per patient.
  
  
  CONCLUSIONS
  A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.
authors.affiliation: Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Boston, MA 02215, USA. david_eisenberg@hms.harvard.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Eisenberg
authors.forename: Diana E
authors.initials: DE
authors.lastname: Post
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Connelly
authors.forename: Anna T R
authors.initials: AT
authors.lastname: Legedza
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Hrbek
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects / Q000191:economics; D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects / Q000191:economics; D008405:Massage / Q000009:adverse effects / Q000191:economics; D008875:Middle Aged; D017060:Patient Satisfaction; D016896:Treatment Outcome