Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

Pedro Serrano-Aguilar, Francisco M Kovacs, Jose M Cabrera-Hernández, Juan M Ramos-Goñi, Lidia García-Pérez, Pedro Serrano-Aguilar, Francisco M Kovacs, Jose M Cabrera-Hernández, Juan M Ramos-Goñi, Lidia García-Pérez

Abstract

Background: Back, neck and shoulder pain are the most common causes of occupational disability. They reduce health-related quality of life and have a significant economic impact. Many different forms of physical treatment are routinely used. The objective of this study was to estimate the cost of physical treatments which, despite the absence of evidence supporting their effectiveness, were used between 2004 and 2007 for chronic and non-specific neck pain (NP), back pain (BP) and shoulder pain (SP), within the Spanish National Health Service in the Canary Islands (SNHSCI).

Methods: Chronic patients referred from the SNHSCI to private physical therapy centres for NP, BP or SP, between 2004 and 2007, were identified. The cost of providing physical therapies to these patients was estimated. Systematic reviews (SRs) and clinical practice guidelines (CPGs) for NP, BP and SP available in the same period were searched for and rated according to the Oxman and AGREE criteria, respectively. Those rated positively for ≥70% of the criteria, were used to categorise physical therapies as Effective; Ineffective; Inconclusive; and Insufficiently Assessed. The main outcome was the cost of physical therapies included in each of these categories.

Results: 8,308 chronic cases of NP, 4,693 of BP and 5,035 of SP, were included in this study. Among prescribed treatments, 39.88% were considered Effective (physical exercise and manual therapy with mobilization); 23.06% Ineffective; 13.38% Inconclusive, and 23.66% Insufficiently Assessed. The total cost of treatments was € 5,107,720. Effective therapies accounted for € 2,069,932.

Conclusions: Sixty percent of the resources allocated by the SNHSCI to fund physical treatment for NP, BP and SP in private practices are spent on forms of treatment proven to be ineffective, or for which there is no evidence of effectiveness.

Figures

Figure 1
Figure 1
Distribution of physical therapies administered according to the evidence of effectiveness and its corresponding costs to patients with chronic nonspecific NP, BP or SP in Spanish National Health Service. Legend: I: Proven ineffective, E: Proven effective, IE: Inconclusive evidence on effectiveness, IA: Insufficiently Assessed.

References

    1. Andersson GBJ. In: The Adult Spine: Principles and Practice. 2. Frymoyer JW, editor. New York: Raven Press; 1997. The epidemiology of spinal disorders; pp. 93–141.
    1. Kvarnstrom S. Occurrence of musculoskeletal disorders in a manufacturing industry with special attention to occupational shoulders. Scand J Rehab Med. 1983;8(Suppl):1–114.
    1. Cailliet R. Shoulder pain. 3. Philadelphia: F.A. Davis Co; 1991.
    1. Sáinz de Murieta E, Fernández Baraibar J, Pascual I, Mena A, Martínez-Zubiri A, Condón MJ. Occupational disability due to locomotor pathology in the Foral Community of Navarra. Epidemiological aspects. An Sist Sanit Navar. 2005;28(1):83–92.
    1. Rajala U, Keinänen-Kiukaanniemi S, Uusimäki A, Kivelä SL. Musculoskeletal pain and depression in a middle-aged Finnish population. Pain. 1995;61(3):451–457. doi: 10.1016/0304-3959(94)00206-T.
    1. Côté P, Kristman V, Vidmar M, Van Eerd D, Hogg-Johnson S, Beaton D, Smith PM. The prevalence and incidence of work absenteeism involving neck pain: a cohort of Ontario lost-time claimants. Spine. 2008;33(Suppl 4):S192–198.
    1. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000;84(1):95–103. doi: 10.1016/S0304-3959(99)00187-6.
    1. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain. 1995;62(2):233–240. doi: 10.1016/0304-3959(94)00272-G.
    1. Waddell G, Burton K, Aylward M. Work and common health problems. J Insur Med. 2007;39(2):109–120.
    1. Ministry of Health and Consumption [Homepage] Madrid: Ministry of Health and Consumption; 2006. Spanish National Survey of Health 2006.
    1. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about back pain? JAMA. 1992;268(6):760–765. doi: 10.1001/jama.1992.03490060092030.
    1. Bassols A, Bosch F, Campillo M, Baños JE. Back pain in the general population of Catalonia (Spain). Prevalence, characteristics and therapeutic behavior. Gac Sanit. 2003;17(2):97–107. doi: 10.1157/13046566.
    1. Ballina Garcia FJ, Hernandez Mejía R, Martín Lascuevas P, Fernandez Santana J, Cueto Espinar A. Epidemiology of musculoskeletal complaints and use of health services in Asturias, Spain. Scand J Rheumatol. 1994;23(3):137–141. doi: 10.3109/03009749409103046.
    1. Pope DP, Croft PR, Pritchard CM, Silman AJ. Prevalence of shoulder pain in the community: the influence of case definition. Ann Rheum Dis. 1997;56:308–312. doi: 10.1136/ard.56.5.308.
    1. OECD -Organisation for Economic Co-Operation and Development- Health Data. 2010. [Internet database]
    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G. COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–S300.
    1. Spanish Working Group of European Programme COST B13. Clinical Practice Guideline for Unspecific Back Pain. 2005.
    1. Merskey H, Bogduk N. Classification of chronic pain. Description of chronic pain syndromes and definitions of pain terms. 2. IASP Press; 1994. pp. 60–74.
    1. The AGREE Collaboration. AGREE Instrument Spanish version, Appraisal of guidelines for research and evaluation.
    1. Oxman AD, Cook DJ, Guyatt GH. User's Guides to the medical literature. VI. How to use an overview. JAMA. 1994;272(17):1367–1371. doi: 10.1001/jama.1994.03520170077040.
    1. Philadelphia Panel. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on selected rehabilitation interventions for neck pain. Phys Ther. 2001;81(10):1701–1717.
    1. Ezzo J, Haraldsson BG, Gross AR, Myers CD, Morien A, Goldsmith CH, Bronfort G, Peloso PM. Cervical Overview Group. Massage for mechanical neck disorders: a systematic review. Spine. 2007;32(3):353–62. doi: 10.1097/01.brs.0000254099.07294.21.
    1. Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G, Cervical Overview Group. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2005. p. CD004250.
    1. Kroeling P, Gross AR, Goldsmith CH. Cervical Overview Group. A Cochrane review of electrotherapy for mechanical neck disorders. Spine. 2005;30(21):E641–E648. doi: 10.1097/01.brs.0000184302.34509.48.
    1. Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri SA, Mortaz Hejri SO, Jonaidi A. Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev. 2008. p. CD005107.
    1. Khadilkar A, Milne S, Brosseau L, Wells G, Tugwell P, Robinson V, Shea B, Saginur M. Transcutaneous electrical nerve stimulation for the treatment of chronic back pain: a systematic review. Spine. 2005;30(23):2657–2666. doi: 10.1097/01.brs.0000188189.21202.0f.
    1. Clarke JA, van Tulder MW, Blomberg SEI, de Vet HC, van der Heijden GJ, Bronfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007. p. CD003010.
    1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005. p. CD000335.
    1. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine. 2006;31(9):998–1006. doi: 10.1097/01.brs.0000214881.10814.64.
    1. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004. p. CD000447.
    1. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003. p. CD004258.
    1. Verhagen AP, Karels C, Bierma-Zeinstra SM, Feleus A, Dahaghin S, Burdorf A, Koes BW. Exercise proves effective in a systematic review of work-related complaints of the arm, neck or shoulder. J Clin Epidemiol. 2007;60(2):110–117.
    1. Chow RT, Barnsley L. Systematic review of the literature of low-level laser therapy (LLLT) in the management of neck pain. Lasers Surg Med. 2005;37(1):46–52. doi: 10.1002/lsm.20193.
    1. Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther. 2007;30(6):473–478.
    1. Plat E, Scherer M, Van Weel C. The treatment of neck pain. A systematic review. Huisarts Wet. 2007;50(13):660–665.
    1. Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G, Cervical overview group. Manipulation and mobilisation for mechanical neck disorders. Cochrane Database Syst Rev. 2004. p. CD004249.
    1. Chou R, Huffman LH. American Pain Society. American College of Physicians. Nonpharmacologic therapies for acute and chronic back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492–504.
    1. Pichón RA, Augustovski F, Alcaraz A, Bardach A, Ferrante D, Garcia MS. Transcutaneous electrical nerve stimulation (TENS-PENS) for back pain. Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS); 2006.
    1. Ho C. Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain) [Issues in emerging health technologies issue 96 part 3] Ottawa: Canadian Agency for Drugs and Technologies in Health; 2007.
    1. Harniman E, Carette S, Kennedy C, Beaton D. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther. 2004;17(2):132–151. doi: 10.1197/j.jht.2004.02.003.
    1. Glass LS, editor. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery of workers. 2. Beverly Farms: OEM Press; 2004. Neck and upper back complaints; pp. 164–193.
    1. Clinical Guidelines for the Queensland Workers compensation Scheme. Back. Queensland: Q-Comp; 2008. Cervical/thoracic; pp. 88–92.
    1. Gross AR, Kay TM, Kennedy C, Gasner D, Hurley L, Yardley K, Hendry L , McLaughlin L. Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. Man Ther. 2002;7(4):193–205. doi: 10.1054/math.2002.0477.
    1. Philadelphia Panel. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on selected rehabilitation interventions for shoulder pain. Phys Ther. 2001;81(10):1719–1730.
    1. CKS [Homepage] United Kingdom: National Library for Health. NHS; 2005. Clinical topics. Neck pain.
    1. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK. Clinical Efficacy Assessment Subcommittee of the American College of Physicians. American College of Physicians. American Pain Society Back Pain Guidelines Panel. Diagnosis and treatment of back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–491.
    1. Koes BW, Sanders RJ, Tuut MK. Kwaliteitsinstituut voor de Gezondheidszorg CBO. The Dutch Institute for Health Care Improvement (CBO) guideline for the diagnosis and treatment of a specific acute and chronic back complaints. Ned Tijdschr Geneeskd. 2004;148(7):310–314.
    1. American College of Occupational and Environmental Medicine (ACOEM) Shoulder complaints. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004.
    1. New Zealand Guidelines Group. The diagnosis and management of soft tissue shoulder injuries and related disorders. Best practices evidence based guideline. New Zealand Guidelines Group; 2004.
    1. Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomás M, Mir MA, Cano A, Muriel A, Zamora J, Gil del Real MT, Gestoso M, Mufraggi N. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008;9:43. doi: 10.1186/1471-2474-9-43.
    1. Pool JJM, Ostelo RWJG, Hoving JL, Bouter LM, de Vet HCW. Minimal clinically important change of the neck disability index and the numerical rating scale for patients with neck pain. Spine. 2007;32(26):3047–3051. doi: 10.1097/BRS.0b013e31815cf75b.
    1. Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, Muriel A, Zamora J, Gil del Real MT, Gestoso M, Mufraggi N. Spanish Back Pain Research Network. Minimal clinically important change for pain intensity and disability in patients with nonspecific back pain. Spine. 2007;32(25):2915–2920. doi: 10.1097/BRS.0b013e31815b75ae.
    1. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient Expectations of Treatment for Back Pain. A Systematic Review of Qualitative and Quantitative Studies. Spine. 2004;29(20):2309–2318. doi: 10.1097/01.brs.0000142007.38256.7f.
    1. Geraets JJ, Goossens ME, de Bruijn CP, de Groot IJ, Köke AJ, Pelt RA, Van der Heijden G, Dinant GJ, van den Heuvel WJ. Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. Int J Technol Assess Health Care. 2006;22(1):76–83.
    1. Schers H, Wensing M, Huijsmans Z, van Tulder M, Grol R. Implementation barriers for general practice guidelines on back pain a qualitative study. Spine. 2001;26(15):E348–E353. doi: 10.1097/00007632-200108010-00013.
    1. Kmietowicz Z. NICE is to root out ineffective treatments in NHS. BMJ. 2006;333:568.
    1. Gallego G, Haas M, Hall J, Viney R. Centre for Health Economics Research and Evaluation. University of Technology Sydney. Working Paper 2010/5; Reducing the use of ineffective health care interventions.
    1. Kovacs FM, Llobera J, Abraira V, Lázaro P, Pozo F, Kleinbaum D. the KAP Group. Effectiveness and cost effectiveness analysis of neuroreflexotherapy for subacute and chronic low back pain in routine general practice. A cluster randomized, controlled trial. Spine. 2002;27(11):1149–1159. doi: 10.1097/00007632-200206010-00004.
    1. Urrútia G, Burton AK, Morral A, Bonfill X, Zanoli G. Neuroreflexotherapy for non-specific low-back pain. Cochrane Database Syst Rev. 2004. p. CD003009.
    1. Corcoll J, Orfila J, Tobajas P, Alegre L. Implementation of neuroreflexotherapy for subacute and chronic neck and back pain within the Spanish public health system: audit after one year. Health Policy. 2006;79(2-3):345–357. doi: 10.1016/j.healthpol.2005.11.001.
    1. Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, et al.. The treatment of acute low back pain--bed rest, exercises, or ordinary activity? N Engl J Med. 1995;332(6):351–355. doi: 10.1056/NEJM199502093320602.
    1. Carragee EJ, Deyo RA, Kovacs FM, Peul WC, Lurie JD, Urrútia G, Corbin TP. Clinical Research. Is the Spine Field a Mine Field? Spine. 2009;34(5):423–430. doi: 10.1097/BRS.0b013e318198c962.
    1. Manca A, Dumville JC, Torgerson DJ, Klaber Moffett JA, Mooney MP, Jackson DA, Eaton S. Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost effectiveness analysis. Rheumatology. 2007;46(9):1495–1501. doi: 10.1093/rheumatology/kem183.
    1. Palomo L, Ortún V, García-Benavides F, Marzquez-Calderón S, editor. Gac Sanit. Suppl 1. Vol. 20. 2006. Sespas Report 2006. Maladjustment of Health in developed world; pp. 2–9.
    1. Law 16/2003, of May 28, of Cohesion and Quality for the National Health System. Boletín Oficial del Estado. 2003. pp. 20567–20588.
    1. Ministry of Health and Consumption. Annual Report of the Spanish National Health System 2004. Madrid: Ministry of Health and Consumption; 2006.
    1. Kovacs FM, Fernandez C, Cordero A, Muriel A, González-Luján L. the Spanish Back Pain Research Network. Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management. BMC Health Services Research. 2006;6:57. doi: 10.1186/1472-6963-6-57.
    1. Lindsay DM, Dearness J, McGinley CC. Electrotherapy usage trends in private physiotherapy practice in Alberta. Physiother Can. 1995;47(1):30–34.
    1. Di Lorio D, Henley E, Doughty A. A survey of primary care physician practice patterns and adherence to acute low back problem guidelines. Arch Fam Med. 2000;9(10):1015–1021. doi: 10.1001/archfami.9.10.1015.
    1. Haldeman S, Dagenais SA. A supermarket approach to the evidence-informed management of chronic low back pain. Spine J. 2008;8(1):1–7. doi: 10.1016/j.spinee.2007.10.009.
    1. Dagenais S, Haldeman S. Evidence-Based management of low back pain. St. Louis, Missouri: Elservier Mosby; 2012. pp. 443–449.
    1. Martin BI, Deyo RA, Mirza SK. Expenditures and Health Status Among Adults With Back and Neck Problems. JAMA. 2008;299(6):656–664. doi: 10.1001/jama.299.6.656.
    1. Lambeek LC, van Tulder MW, Swinkels IC, Koppes LL, Anema JR, van Mechelen W. The trend in total cost of back pain in The Netherlands in the period 2002 to 2007. Spine. 2011;36(13):1050–1058. doi: 10.1097/BRS.0b013e3181e70488.

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