Where the United States Spends Its Spine Dollars Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA. Spine
(Impact Factor: 2.3).
03/2012; 37(19):1693-701. DOI: 10.1097/BRS.0b013e3182541f45
Serial, cross-sectional, nationally representative surveys of noninstitutionalized US adults.
To examine expenditures on common ambulatory health services for the management of back and neck conditions.
Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population.
We used the Medical Expenditure Panel Survey to examine adult (aged 18 yr or older) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions.
Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; although physical therapy was the most costly service overall, in recent years those costs have contracted.
Although this study did not explore the relative effectiveness of different ambulatory services, recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions.
Available from: Lisa C Carlesso
- "Disease 2010 study, the overall impact of neck pain 6 on death and disability accounts for one fifth of all 7 musculoskeletal diseases . For those suffering from 8 back and neck conditions, the mean inflation-adjusted 9 annual expenditures on medical care has increased to 10 $950 in the United States . Direct costs can be as-11 cribed to healthcare related contacts, medication use 12 and other socioeconomic costs (i.e. "
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Examination of practice patterns compared to existing evidence identifies knowledge to practice gaps.OBJECTIVES: To describe the utilization of pharmacological, patient education, primary psychological interventions and relaxation therapies in patients with neck pain by clinicians.
An international cross-sectional survey was conducted to determine the use of these interventions amongst 326 clinicians treating patients with neck pain.
Nineteen countries participated. Results were analyzed by usage amongst physical therapists (39%) and chiropractors (35%), as they were the predominant respondents. Patient education (95%) and relaxation therapies (59%) were the most utilized interventions. Tests of subgroup differences determined that physical therapists used patient education significantly more than chiropractors. Use of medications and primary psychological interventions were reported by most to be outside of scope of practice. The high rate of patient education is consistent with supporting evidence. However, usage of relaxation therapies is contrary to evidence suggesting no benefit for improved pain or function for chronic neck pain.
This survey indicates that patient education and relaxation therapies are common treatments provided by chiropractors and physical therapists for patients with neck pain. Future research should address gaps associated with variable practice patterns and knowledge translation to reduce usage of interventions shown to be ineffective.
Available from: Rafael Zambelli Pinto
- "Nevertheless, the effect of most conservative treatments is only small to moderate (Keller et al., 2007). In this context, referrals to secondary care of those with chronic and disabling symptoms are common and considered to be a significant contributor to the economic burden of LBP (Davis et al., 2012; Hong et al., 2013). The challenge of finding optimum treatment for LBP has shifted the attention to the identification of prognostic factors (Hayden et al., 2010). "
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ABSTRACT: Physical deconditioning in combination with societal and emotional factors has been hypothesized to compromise complete recovery from low back pain (LBP). However, there is a lack of longitudinal studies designed to specifically investigate physical activity as an independent prognostic factor. We conducted a prognostic study to investigate whether levels of leisure time physical activity are independently associated with clinical outcomes in people seeking care for chronic and persistent LBP.
A total of 815 consecutive patients presenting with LBP to an outpatient spine centre in secondary care were recruited. Separate multivariate linear regression analyses were performed to investigate whether levels of leisure time physical activity (i.e., sedentary, light and moderate-to-vigorous leisure time physical activity levels) predict pain and disability at 12-month follow-up, after adjusting for age, pain, episode duration, disability, neurological symptoms, depression and fear of movement.
Final models showed evidence of an association between baseline physical activity and 12-month outcomes (p < 0.001). In both models, the moderate-to-vigorous physical activity group reported less pain and disability compared with the sedentary group.
Our findings suggest that physical activity levels may have a role in the prognosis of LBP. Specific domains of physical activity warrant further investigation to better understand this association.
Available from: Christine M Goertz
- "During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable. Physical therapy was the most costly service overall . Spinal manipulation is used by doctors of chiropractic (DC), osteopathic physicians, and physical therapists to treat musculoskeletal disorders     . "
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ABSTRACT: The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction.
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