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Chiropractic Research Review

Manual Therapy More Effective Than Physiotherapy, Drugs for Neck Pain

Neck problems account for considerable pain and stiffness that can lead to work absenteeism, disability and use of health care resources. Various conservative interventions have been proposed for treating neck pain, but few scientific evaluations

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have included any analysis of their cost-effectiveness.

This randomized, controlled trial compared the efficacy of manual therapy, physiotherapy and general practitioner care in reducing neck pain. One hundred eighty-three patients with neck pain of at least two weeks' duration were randomly assigned to one of three groups: manual therapy (spinal mobilization); physiotherapy (mainly exercise); or general practitioner care (counseling, education and analgesics). Manual therapy consisted of a range of interventions: muscular mobilization, specific articular mobilization, coordination or stabilization. Spinal mobilization was defined as low-velocity, passive movements within or at the limit of joint range of motion.

Outcome measures included perceived recovery, intensity of pain, functional disability and quality of life; direct and indirect costs were measured to determine mean costs between groups, overall cost-effectiveness, and cost-utility ratios. Patients completed cost diaries for one year, providing data on direct health care costs of practitioner care; additional visits to other health care providers; drugs; professional home care; and hospitalization. Direct non-health care costs included out-of-pocket expenses; paid and unpaid help; and travel expenses. Indirect costs (lost of production attributable to work absenteeism or days of inactivity for those with or without a job) also were evaluated.

Results: Manual therapy was the most effective of the three treatments, with 68% of patients demonstrating recovery after seven weeks, compared to 51% in the physiotherapy group and 36% in the general practitioner group. These differences were significant at six-month follow-up. Manual therapy also proved significantly more cost-effective than the other two interventions at one year, with total costs approximately one-third the costs of either physiotherapy or general practitioner care.

Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, April 26, 2003:326. www.bmj.com

Chiropractic Research Review

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