Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study

• Published in: PloS one Vol. 12; no. 5; p. e0177255
• Main Authors: Walker, Jochen, Mertens, Ulf Kai, Schmidt, Carsten Oliver, Chenot, Jean-François
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15-05-2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Analysis; Care and treatment; Case-Control Studies; Cohort analysis; Cohort Studies; Combined Modality Therapy; Employee benefits; Female; Finance; Flags; Health; Health care; Health Care Costs; Health insurance; Health services utilization; Humans; Low back pain; Low Back Pain - diagnosis; Low Back Pain - epidemiology; Low Back Pain - therapy; Male; Manipulation, Spinal - economics; Manipulation, Spinal - methods; Manipulative therapy; Medical care utilization; Medical personnel; Medicine and Health Sciences; Middle Aged; Pain; Patient Acceptance of Health Care; Patient outcomes; Patients; People and Places; Physical therapy; Physicians; Propensity Score; Sick Leave; Spinal manipulation; Studies; Therapy; Utilization; Young Adult; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0177255

Spinal manual therapy (SMT) is a popular treatment option for low back pain (LBP). The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18%) received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]). SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services.