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- Lilje, Stina, et al.
(författare)
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Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low-prioritized Orthopedic Outpatients of Working Age A Cost Consequence Analysis
- 2014
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams. - 0749-8047 .- 1536-5409. ; 30:8, s. 730-736
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. Materials and Methods: Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. Results: Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro = 106,213 SEK; 1 US Dollar = 76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." Discussion: It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.
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| 2. |
- Lilje, Stina, et al.
(författare)
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Naprapathic Manual Therapy or Conventional Orthopedic Care for Outpatients on Orthopedic Waiting Lists? A pragmatic randomized controlled trial.
- 2010
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 26:7, s. 602-610
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery. Methods: Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated. Results: After 52 weeks, statistically significant differences betweenthe groups were found regarding impairment in pain, increasedphysical function, and regarding perceived recovery, favoring theindex group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%. Discussion: The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.
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