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Association Between the Type of First Healthcare Provider

By |March 8, 2017|Chiropractic Care, Cost-Effectiveness|

Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain

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SOURCE:   Journal of Occupational Rehabilitation 2016 (Sep 17)


Marc-André Blanchette, Michèle Rivard, Clermont E. Dionne, Sheilah Hogg-Johnson, Ivan Steenstra

Public Health PhD Program,
School of Public Health,
University of Montreal,
Montreal, QC, Canada.


Objective   To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers.

Methods   We analyzed data from a cohort of 5,511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period.

Results   Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference).

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Early Predictors of Lumbar Spine Surgery

By |March 7, 2017|Chiropractic Care, Cost-Effectiveness|

Early Predictors of Lumbar Spine Surgery After Occupational Back Injury: Results From a Prospective Study of Workers in Washington State

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SOURCE:   Spine (Phila Pa 1976). 2013 (May 15); 38 (11): 953–964


Benjamin J. Keeney, PhD, Deborah Fulton-Kehoe, PhD, MPH, Judith A. Turner, PhD, Thomas M. Wickizer, PhD, Kwun Chuen Gary Chan, PhD, and Gary M. Franklin, MD, MPH

Department of Orthopaedics,
Geisel School of Medicine at Dartmouth College,
Lebanon, NH 03756, USA.


STUDY DESIGN:   Prospective population-based cohort study.

OBJECTIVE:   To identify early predictors of lumbar spine surgery within 3 years after occupational back injury.

SUMMARY OF BACKGROUND DATA:   Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury.

METHODS:   Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model’s ability to identify correctly workers who underwent surgery.

RESULTS:   In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery.

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This On-site Chiropractic Clinic Is Saving a Manufacturer Money

By |March 6, 2017|Cost-Effectiveness|

This On-site Chiropractic Clinic Is Saving a Minnesota Manufacturer Big Money

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SOURCE:   The Star Tribune ~ Jan 1, 2017   


By Christopher Cassirer

Northwestern Health Sciences University
Bloomington, MN.


A year into the project, workers report that they are feeling better and like having health care services at their job. Statistics show that they are incurring injuries at much lower rates. They are also recovering quicker when they do get hurt. And when it comes to the bottom line, the results have been better than Friendship Homes and Northwestern expected. For every $1 that the company has invested in the program, it is saving $8 by avoiding more-costly and less-effective treatments, spending less on insurance payments and keeping more workers on the job in the first place, which generates savings through less lost tine for workers and less overtime to compensate for absences.

As our nation struggles to find an affordable, effective future for health care, some answers may come from an experiment at a midsize employer in Montevideo, Minn.

Friendship Homes, with 180 employees, is one of the largest employers in the town of 5,400 about 130 miles west of the Twin Cities. The company builds prefabricated homes. And like many in construction and related industries, it has struggled to help its employees with back and muscle pain and other injuries caused by strain and overuse.

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A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

By |February 24, 2017|Chiropractic Care, Cost-Effectiveness|

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for
Spine Pain in the United States

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SOURCE:   BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT


Simon Dagenais, O’Dane Brady, Scott Haldeman and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.


BACKGROUND:   Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.

METHODS:   A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining:

1.   private health plans
2.   workers’ compensation (WC) plans, and
3.   clinical outcomes.

The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.

RESULTS:   The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.

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Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain

By |November 12, 2016|Chiropractic Care, Chronic Low Back Pain, Cost-Effectiveness|

Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes from a Randomized Controlled Trial

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SOURCE:   J Manipulative Physiol Ther. 2014 (Jun); 37 (5): 300–311


Darcy A. Vavrek, ND, MS, Rajiv Sharma, PhD,
Mitchell Haas, DC, MA

University of Western States,
Portland, OR.


OBJECTIVE:   The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

METHODS:   We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

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Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

By |October 25, 2016|Cost-Effectiveness|

Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

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SOURCE:   Eur Spine J. 2011 (Jul); 20 (7): 1012–1023


Chung-Wei Christine Lin, Marion Haas, Chris G. Maher,
Luciana A. C. Machado, Maurits W. van Tulder

The George Institute for Global Health and
Sydney Medical School,
The University of Sydney,
PO Box M201, Missenden Rd,
Sydney, NSW 2050, Australia.


Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data.

Eleven studies were included; the majority of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone.

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