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

Study Design. 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). Summary of Background Data. 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 chi(2)) 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.