Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel

ObjectiveTo evaluate the cost–utility of 100 days of antibiotics in patients with chronic low back pain (LBP) and type I or II Modic changes included in the Antibiotic treatment In patients with chronic low back pain and Modic changes (AIM) study.DesignA cost–utility analysis from a societal and healthcare perspective alongside a double-blinded, parallel group, placebo, multicentre trial.SettingHospital outpatient clinics at six hospitals in Norway. The main results from the AIM study showed a small effect in back-related disability in favour of the antibiotics group, and slightly larger in those with type I Modic changes, but this effect was below the pre-defined threshold for clinically relevant effect.Participants180 patients with chronic LBP, previous disc herniation and Modic changes type I (n=118) or type II (n=62) were randomised to antibiotic treatment (n=89) or placebo-control (n=91).InterventionsOral treatment with either 750 mg amoxicillin or placebo three times daily for 100 days.Main outcome measuresQuality-adjusted life years (QALYs) by EuroQoL-5D over 12 months and costs for healthcare and productivity loss measured in Euro (€1=NOK 10), in the intention-to-treat population. Cost–utility was expressed in incremental cost-effectiveness ratio (ICER).ResultsMean (SD) total cost was €21 046 (20 105) in the amoxicillin group and €19 076 (19 356) in the placebo group, mean difference €1970 (95% CI; −3835 to 7774). Cost per QALY gained was €24 625. In those with type I Modic changes, the amoxicillin group had higher healthcare consumption than the placebo group, resulting in €39 425 per QALY gained. Given these ICERs and a willingness-to-pay threshold of €27 500 (NOK 275 000), the probability of amoxicillin being cost-effective was 51%. Even when the willingness-to-pay threshold increased to €55 000, the probability of amoxicillin being cost-effective was never higher than 53%.ConclusionsAmoxicillin treatment showed no evidence of being cost-effective for people with chronic LBP and Modic changes during 1-year follow-up.Trial registration numberClinicalTrials.gov NCT02323412.

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A review of behaviour change theories and techniques used in group based self-management programmes for chronic low back pain and arthritis

Manual Therapy ◽

10.1016/j.math.2015.03.014 ◽

2015 ◽

Vol 20 (6) ◽

pp. 727-735 ◽

Cited By ~ 42

Author(s):

Alison Keogh ◽

Mark A. Tully ◽

James Matthews ◽

Deirdre A. Hurley

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Behaviour Change ◽

Chronic Low Back Pain ◽

Self Management ◽

Low Back

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Intensive rehabilitation may be more cost effective than surgical stabilisation for chronic low back pain

Australian Journal of Physiotherapy ◽

10.1016/s0004-9514(05)70015-5 ◽

2005 ◽

Vol 51 (4) ◽

pp. 269

Author(s):

David Epstein

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Cost Effective ◽

Low Back ◽

Intensive Rehabilitation

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Yoga and Chronic Low Back Pain

International Journal of Yoga Therapy ◽

10.17761/ijyt.20.1.9035r0571171j701 ◽

2010 ◽

Vol 20 (1) ◽

pp. 53-54

Author(s):

Neil Pearson

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Research Evidence ◽

Cost Effective ◽

Effective Intervention ◽

Low Back ◽

Growing Body ◽

The One

Recently, on a number of occasions, I have come across the statement, "Research supports that Yoga decreases low back pain." This led me to consider the level of clarity and truth of this statement. Many of my students would agree with this statement, and there is a growing body of research suggesting that Yoga should be considered as an effective and cost-effective intervention for people with chronic low back pain. However, the research evidence does not support making such a broad statement as the one above.

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Perspectives on physiotherapy guidelines for chronic low back pain

South African Journal of Physiotherapy ◽

10.4102/sajp.v63i3.138 ◽

2007 ◽

Vol 63 (3) ◽

Cited By ~ 2

Author(s):

P. Berger

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Management ◽

Chronic Low Back Pain ◽

Chronic Back Pain ◽

Cost Effective ◽

International Studies ◽

Low Back ◽

Positive Role ◽

Health And Healing

The prevalence of chronic low back pain presents a world widedilemma to patients, physiotherapists and clinicians. There is scant evidence for prevention and treatment however it is now acknowledged that the use of physiotherapy in a multidimensional context has proved the more appropriate model as a vital component of the collaborative approach required for effective pain management. The following article reviews the current literature, evaluates and combines the guidelines that have been proposed from various international studies to provide a practical approach to the management of chronic back pain. This approach recognizes a broad biopsychosocial model of health and the positive role of activity in health and healing with emphasis on function, rather than impairment. Therefore the development of a patient-centred rehabilitative approach has emerged that emphasizes the restoration of normal movement and function with the addition of physical modalities where appropriate. Recent advances in neurophysiology, the modulation of pain and its perception and the fact that biological systems are known to be greatly affected by electrical treatment provide a clearer rationale for the use of physical agents for rehabilitation of patients with pain and relateddisability. The modalities used in conjunction with active exercises include thermal, massage, electrical stimulation, traction, transcutaneous electrical nerve stimulation (Tens), myofascial release, dry needling, mobilization and acupuncture. An algorithm is provided with the intention of developing protocols for breaking the pain cycle in both nociceptive and neuropathic pain states and in reducing inflammation which is a component of both peripheral and central sensitization. Pain rehabilitation is a useful and cost-effective approach to chronic pain management and makes patients’ responsible partners in their own progress. It encourages planning, pacing of activities and activity related goal setting into a clear and goal-oriented context that provides the patient with control and improved quality of life.

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