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Comparing Treatment Programs for Back Pain Based on Cost Savings

Is there an exercise program that would help patients for the same cost (or less) than usual physical therapy care? A group of researchers from the Netherlands say No -- at least for the group of patients used in this study and with the type of program prescribed.

Two groups of low back pain (LBP) patients were included. One group received usual care with a physical therapist. The second group received intensive training with exercise, back school, and behavioral principles. Both programs were supervised by a physical therapist. Everyone in the study was followed for a full year.

Results were measured on the basis of pain, function, and quality of life. Direct and indirect costs were totaled up for both groups as well. Work absenteeism and the cost of health care were part of the cost analysis. Health care included medications, visits to traditional or alternative specialists, and the intervention groups used in this study. The health care costs were labeled as resource-use.

There was no difference in total costs between the two groups. Direct training costs were higher in the intensive training group. This was related to two factors: 1) the cost of the intervention, which included 10 individual sessions and 20 group sessions with the therapist. 2) Patients in the intensive training program used more alternative resources while waiting for their training group to start up.

The authors conclude that there weren't enough cost savings to recommend the intensive training program with all LBP patients. This is not to say that the program shouldn't be used wherever it is already in place. There may be some work settings where the cost savings in reduced worker absenteeism outweigh the cost of the program.

Getting started with this type of training program right away and following it more closely might also make a decided difference in cost savings. More study is needed to understand all the economic factors in treating chronic LBP.

References: Nicole van der Roer, PhD, et al. Economic Evaluation of an Intensive Group Training Protocol Compared with Usual Care Physiotherapy in Patients with Chronic Low Back Pain. In Spine. February 15, 2008. Vol. 33. No. 4. Pp. 445-451.

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