Manipulation and Stabilizing Exercise for Chronic Low Back Pain
Attached is a recently published paper by Niemisto and colleagues reporting a 2-year follow-up regarding the cost-effectiveness of manipulation, stabilizing exercises, and physician consultation versus physician consultation alone for patients with chronic LBP. Although clinical outcomes favored the combined manipulation and stabilizing exercise group (both pain and satisfaction), the one-point VAS improvement came at a cost of $512. The authors concluded that "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." There are some potential classification issues that may have muted some of the potential differences, but it's nice to see research that incorporates a cost-related analysis. The published report at 1 year (also attached) was more favorable, reminding us that treatment may still be worthwhile (getting patients better earlier), despite the fact that treatment effects may wash out 2 years later.
John
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