Cost effectiveness of physiotherapy, manual therapy and general practitioner care for neck pain- a randomized, controlled trial

 

Chiropractic care or general practitioner care for your neck pain

Neck pain is the most common health problem condition that affects around 1/6 of men and 1/4 of women in the Netherlands. Neck pain problem is not life threatening but can cause much pain and stiffness and often result in using health care resources, absenteeism from work and disability to perform normal day-to-day activities and responsibilities.

 

Comparison of care with manual therapy, physiotherapy and general practictioner

183 patients were examined in this Netherlands study. Each person suffered from some sort of neck pain within the last two weeks.Patients were recruited by 42 general practitioners and were randomly allocated to

• Manual therapy that deals with spinal mobilization (this group included chiropractors)
• Physiotherapy which is primarily exercise
• General practitioner care which consist of counseling, education and proper drugs prescription.

Their main objective was to evaluate the effectiveness of physiotherapy, manual therapy and care of the general practitioner for the patient who suffer from neck pain. They performed an economic evaluation alongside a randomized controlled trial to evaluate the cost effectiveness of mutual therapy, physiotherapy and general practitioner care for patient with non-specific neck pain.

 

Forty two general practitioners recruited patients from 1997 to 1998. The general practitioners were randomly selected from a representative group of general practitioners. The inclusion criteria were neck pain for at least two weeks, ages to 18-70and willingness to comply with treatment and follow up measurements. Exclusion criteria were physiotherapy or manual therapy for neck pain in the previous six months, surgery of neck a specific cause for the neck pain (e.g. malignancy, fracture and inflammation).

 

Eligible patients were enrolled and gave their written information consent after physical examination and baseline assessment. An administrative assistant allocated patients to one of the three intervention groups using a computer generated random sequence table for severity of symptoms and for practical reasons and for research center.

 

The patient’s condition could be adapted by three interventions. Manual therapy consisted of a range of interventions including hands-on techniques such as muscular mobilization, coordination and stabilization. Spinal mobilization was provided by chiropractors, osteopaths and physiotherapist using mobilization and manipulation techniques. Physiotherapy was applied by five physiotherapist and consisted of individual exercise therapy such as postural or relaxation exercises, stretching and functional exercises. Additional massage and manual traction is an option. Standardized care was provided by General Practitioner Care. They also deal on discussing the prognosis and factors that aggravated the condition, self care and ergonomic considerations.Patients were allowed to perform home exercise and continue with taking medicine during the intervention period of six weeks

 

Outcomes of best care and treatment for neck pain

Clinical outcomes were perceived  asrecovery, intensity of pain, functional disability and quality of life. The costs were measured by means of  patient diaries. The differences in mean costs between groups cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques.

 

The total cost of neck pain in Netherland is estimated at $686 million in a year. There are many conservative interventions are available for treating neck pain, like analgesics prescribed by general practitioners, physiotherapists, and manual therapists.

 

Manual therapy for treatment of neck pain was more cost effective

Manual therapy for the treatment of neck pain was more cost effective than physiotherapy or care by a general practitioner. Manual therapy had has lower costs and slightly better effects at 52 weeks compared with physiotherapy and general practitioner care. The clinical outcome measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care up to 26 weeks.

 

A recent study showed that general practitioners in the Netherlands refer most patients with neck pain to physiotherapists instead of manual therapists. Systematic reviews of trials on conservative treatments for acute and chronic neck pain provide little evidence of one treatment being more effective than another. One study, comparing chiropractic and physiotherapy for patients with low back pain and neck pain, included a cost measurement but did not conduct a full economic evaluation. Our economic evaluation alongside a pragmatic randomized controlled trial showed manual therapy to be more cost effective than physiotherapy and continued care provided by a general practitioner in the treatment of non-specific neck pain.