Costs and Outcomes of Chiropractic Treatment for Low Back Pain: Evidence from the US and Australia
- Presenter:
Chair: Randall Ellis; Discussant: Karen Eggleston Mon June 5, 2006 17:15-18:45 Room 235
Issue: Low back pain (LBP) is a common and costly medical problem in industrialized countries. It is experienced by 70% to 80% of adults at some time during their lives. There is uncertainty about the clinical and cost effectiveness of chiropractic care for LBP relative to standard medical treatment or physical therapy.
Objective: To systematically review the evidence on clinical effectiveness, comparative cost, and cost-effectiveness of chiropractic for LBP.
Methodology: The comparators for chiropractic treatment of LBP were conventional medicine and physical therapy. A search strategy was developed for existing systematic reviews of clinical effectiveness, supplemented by a literature search of new RCTs since the end of 2002. Non-RCTs were also covered. A search strategy was also developed for the review of economic evidence. Qualitative analysis was performed on the included effectiveness studies and economic studies. A cost comparison analysis was done using results of the economic review. Quality of the included studies was assessed using the Oxman Guyatt Scale, Jadad Scale, Newcastle Ottawa Quality Assessment Scale, and a quality check for cost studies.
Results: For the effectiveness review, our selection criteria were met by eighteen systematic reviews, and four trials published after the reviews were completed. Ten studies were identified in the economic review. Four were cost comparisons and six were cost consequence studies. Nine were from the US and one was from Australia.
Conclusions: Chiropractic for LBP is similar in effectiveness to standard medical care and physical therapy. The higher quality reviews did not find significant differences in effectiveness. There is no clear cost advantage for any of the three methods studied. In terms of improving lost time from work, chiropractic care was similar to physical therapy; and as effective as or better than standard medical care.
