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Individualized physical therapy is cost-effective compared with guideline-based advice for people with low back disorders [with consumer summary]
Hahne AJ, Ford JJ, Surkitt LD, Richards MC, Chan AYP, Slater SL, Taylor NF
Spine 2017 Feb;42(3):E169-E176
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: A cost-utility analysis within a randomized controlled trial was conducted from the health care perspective. OBJECTIVE: The aim of this study was to determine whether individualized physical therapy incorporating advice is cost-effective relative to guideline-based advice alone for people with low back pain and/or referred leg pain (> 6 weeks, < 6 months duration of symptoms). SUMMARY OF BACKGROUND DATA: Low back disorders are a burdensome and costly condition across the world. Cost-effective treatments are needed to address the global burden attributable to this condition. METHODS: Three hundred participants were randomly allocated to receive either two sessions of guideline-based advice alone (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial and neurophysiological factors, and incorporating advice (n = 156). Data relating to health care costs, health benefits (EuroQol-5D) and work absence were obtained from participants via questionnaires at 5, 10, 26, and 52-week follow-ups. RESULTS: Total health care costs were similar for both groups: mean difference $27.03 (95% confidence interval (95% CI) -200.29 to 254.35). Health benefits across the 12-month follow-up were significantly greater with individualized physical therapy: incremental quality-adjusted life years 0.06 (95% CI 0.02 to 0.10). The incremental cost-effectiveness ratio was $422 per quality-adjusted life year gained. The probability that individualized physical therapy was cost-effective reached 90% at a willingness-to-pay threshold of $36,000. A saving of $1,995.51 (95% CI $143.98 to $3,847.03) per worker in income was realized in the individualized physical therapy group relative to the advice group. Sensitivity and subgroup analyses all revealed a dominant position for individualized physical therapy; hence, the base case analysis was the most conservative. CONCLUSION: Ten sessions of individualized physical therapy incorporating advice is cost-effective compared with two sessions of guideline-based advice alone for people with low back disorders. LEVEL OF EVIDENCE: 2.
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