Cost-effectiveness of manual therapy versus physiotherapy in chronic nonspecific neck pain

Study Type: Economic Analysis
OE Level of Evidence: 2
Journal Level of Evidence: N/A
181 patients with sub-acute or chronic neck pain were randomized to receive either manual therapy, according the Utrecht School guideline (MTU), or standard physiotherapy (PT). The purpose of this secondary analysis was to evaluate the cost-effectiveness of MTU compared to PT. Cost differences were Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Spaarneland Health Care Foundation
Conflicts: Other
Why was this study needed now?
Conservative treatments options for patients with sub-acute and chronic neck pain include the use of analgesics, manual therapy, exercise therapy, and physiotherapy either singularly or in some combination of therapies. Recent interest has been placed in manual therapy according to the Utrecht School (MTU), which involves customized diagnostic and treatment techniques combined with popular manual therapies such as stabilization and joint mobilization. Evidence has demonstrated that when compared to traditional physiotherapy, MTU offers similar significant improvements in pain in this patient population in a smaller number of sessions. Therefore, in order to completely compare these two conservative therapies in terms of clinical and economical effectiveness, the present cost-effectiveness analysis was conducted.
What was the principal research question?
In patients with sub-acute or chronic non-specific neck pain, how did manual therapy according to the Utrecht School (MTU) compare with traditional physiotherapy in terms of cost-effectiveness (intervention costs from a societal perspective) and clinical outcomes (perceived recovery, functional status, and quality of life) when assessed throughout a 52-week follow-up period?
Population: 181 patients aged 18-70 years with sub-acute or chronic pain in the cervical region (with or without radicular symptoms).
Intervention: MTU group: patients received manual therapy according to the Utrecht School (MTU), which involved manual therapist-led medical evaluation and successive customized joint mobilization/stabilization exercises of spine and extremities. Manual therapists also provided patient advice regarding physical activity, lifestyle, and exercise. MTU was performed through a maximum of six 30-60 minute sessions occurring every 1-2 weeks (n=90, 61 complete follow-up; mean age= 49.2+/-12.4, 56F).
Comparison: Physiotherapy group: patients performed physiotherapist-led exercises such as muscle stretching, manual traction, and massage. Specifically, manual techniques were not performed in this intervention. Physiotherapy was performed through a maximum of nine 30 minute sessions occurring 1-2 times per week (n=90, 52 completed follow-up; mean age= 48.7+/-12.6, 56F).
Outcomes: Cost-effectiveness outcomes included intervention costs such as intervention, healthcare, informal care, absenteeism, and unpaid productivity costs due to neck pain) converted to Euros 2010 with consumer price indices. Healthcare utilization included care by a primary or secondary healthcare provider, and use of prescribed or OTC medication. Absenteeism referred to as the number of sickness absence days due to patients’ neck pain. Clinical outcomes included perceived recovery (global perceived effect - GPE), functional status (Neck Disability Index (Dutch Version) - NDI-DV), and health-related quality of life (SF-6D).
Methods: RCT: cost-effective analysis
Time: Clinical and cost-effective outcomes of interest were assessed 3, 7, 13, 26, 39, and 52 weeks post-treatment.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.