title: Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.
abstract: OBJECTIVE
  The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.
  
  
  METHODS
  A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.
  
  
  RESULTS
  Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.
  
  
  CONCLUSIONS
  Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.
authors.affiliation: Senior Research Fellow, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsertsvadze
authors.affiliation: Senior Research Fellow, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Clar
authors.affiliation: Information Specialist, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Court
authors.affiliation: Professor, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Aileen
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Assistant Professor, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Hema
authors.initials: H
authors.lastname: Mistry
authors.affiliation: Associate Professor, Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: p.a.sutcliffe@warwick.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Sutcliffe
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D017116:Low Back Pain / Q000628:therapy; D009140:Musculoskeletal Diseases / Q000191:economics* / Q000628:therapy*; D019547:Neck Pain / Q000628:therapy; D026741:Physical Therapy Modalities / Q000191:economics*; D016032:Randomized Controlled Trials as Topic
keywords: Back Pain; Chiropractic; Cost-Effectiveness; Cost-Utility; Manual Therapy; Systematic Review