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Cost and Effectiveness Analysis of Chiropractic and Physiotherapy Treatment for Low Back and Neck Pain: Six-Month Follow-Up

Skargren, Elisabeth I., RPT*; Öberg, Birgitta E., RPT, DrMedSc*; Carlsson, Per G., PhD; Gade, Mikkel, DC

Primary Care

Study Design. A randomized, clinical trial was conducted in which patients with back/neck problems, visiting a general practitioner, were allocated to chiropractic or physiotherapy as primary management.

Objectives. To compare outcome and costs of chiropractic and physiotherapy in managing patients with low back or neck pain.

Summary of Background Data. Earlier studies on the treatment of back pain by spinal manipulation have shown inconsistent results. When a "new" strategy-chiropractic-in the treatment of back pain was introduced in public health care in Sweden, there was a need to compare the effects and costs of chiropractic with the established physiotherapy.

Methods. Three hundred twenty-three patients aged 18 to 60 years who had no contraindications to manipulation and who had not been treated within the previous month were included in the study. Treatment was carried out at the discretion of the therapist. Outcome measures were primarily changes in pain intensity and general health, both assessed with visual analog scale and Oswestry pain disability questionnaire. Direct and indirect costs were measured.

Results. For patients with low back or neck pain visiting the general practitioner in primary care, both chiropractic and physiotherapy as primary treatment reduced the symptoms. No difference in outcome or direct or indirect costs between the two groups could be seen, nor in subgroups defined as duration, history, or severity.

Conclusions. The effectiveness and total costs of chiropractic or physiotherapy as primary treatment were similar to reach the same result after treatment and after 6 months.

From the *Department of Caring Sciences, Section for Rehabilitation, Faculty of Health Sciences, and the †Center for Medical Technology Assessment, Linköping University, Linköping, and ‡Ryggakuten, Läkarhuset Kneippbaden, Norrköping, Sweden.

Supported by the County Council of Ostergötland and the Federation of County Councils, Sweden.

Acknowledgment date: May 21, 1996.

First revision date: September 12, 1996.

Second revision date: December 20, 1996.

Acceptance date: December 26, 1996.

Device status category: 1.

Address reprint requests to: Elisabeth Skargren, RPT; Faculty of Health Sciences; Department of Caring Sciences; S-581 85 Linköping; Sweden.

© Lippincott-Raven Publishers.