title: Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.
abstract: BACKGROUND
  Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP.
  
  
  OBJECTIVE
  The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education.
  
  
  METHODS
  The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation.
  
  
  METHODS
  In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period.
  
  
  RESULTS
  After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing total health care costs. Had the 1,995 soldiers in the PSEP group not received PSEP, we would estimate that 16.7% of them would incur an adjusted median LBP-related health care cost of $517 compared with the current 15.0% soldiers incurring an adjusted median cost of $399, which translates into an actual LBP-related health care cost savings of $52,846 during the POLM trial. However, it is likely that the unaccounted for direct and indirect costs might erase even these small cost savings.
  
  
  CONCLUSIONS
  The results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors.
authors.affiliation: Department of Physical Therapy (MSGS/SGCUY), 81st Medical Group, Keesler Air Force Base, 2532 Melville Ln., Biloxi, MS 39534, USA; U.S. Army-Baylor University Doctoral Program in Physical Therapy (MCCS-HMT), Army Medical Department Center and School, 3151 Scott Rd, Rm 2307, Fort Sam Houston, TX 78234, USA. Electronic address: childsjd@gmail.com.
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
authors.affiliation: Department of Biostatistics, University of Florida, PO Box 100177, Gainesville, FL 32610-0177, USA.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy (MCCS-HMT), Army Medical Department Center and School, 3151 Scott Rd, Rm 2307, Fort Sam Houston, TX 78234, USA; Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Material Command, Ft Detrick, MD 21774, USA.
authors.forename: Deydre S
authors.initials: DS
authors.lastname: Teyhen
authors.affiliation: Center for Pain Research and Behavioral Health, University of Florida, PO Box 100165, Gainesville, FL 32610, USA; Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Robinson
authors.affiliation: Center for Pain Research and Behavioral Health, University of Florida, PO Box 100165, Gainesville, FL 32610, USA; Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D003365:Costs and Cost Analysis; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006266:Health Education / Q000379:methods*; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000517:prevention & control*; D008297:Male; D008889:Military Personnel; D014481:United States; D055815:Young Adult
keywords: Biopsychosocial; Costs; Low back pain; Military; Prevention