Musculoskeletal complaints are one of the most common reasons for seeking physician care. Here is a list of case studies with interesting data for comparison.
Estimates And Patterns Of Direct Health Care Expenditures Among Individuals With Back Pain In The United States Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Spine. 2004 Jan 1;29(1):79-86
In this study researchers analyzed data from a 1998 Medical Expenditure survey. $26 billion was attributed to back pain. Individuals with back pain spent 60% more on overall health care than those without back pain. This cost analysis study conflicts with the experts that claim back pain is a benign, self-limiting condition.
Lost Productive Time And Cost Due To Common Pain Conditions In The US Workforce Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton. JAMA. 2003 Nov 12;290(18):2443-54
The American productivity audit surveyed 29,000 working adults to quantify the impact of reduced performance at work due to pain. Researchers questioned respondents regarding the cost implications of reduced performance were due to headaches, arthritis, back pain and other musculoskeletal pain. Respondents were also asked if the common pain conditions had caused them to lose concentration, repeat jobs, do nothing or feel fatigued at work. The cost of lost productive time in the US workforce was found to be $61 billion, and 76% of that cost was attributed to health-related reduced performance. This is consistent with prior studies that concluded loss of productive time is more significant than absenteeism. The data revealed that 1.1% of the workforce were absent one or more days per week because of common pain conditions.
Clinical and Cost Outcomes Of An Integrative Medicine IPA. Sarnat, Richard; Winterstein, James Journal of Manipulative and Physiological Therapeutics 2004; 27: 336-347.
In 1999, a large Chicago HMO began to utilize Doctor of Chiropractic (DCs) in a primary care provider role. The DCs focused on assessment and evaluation of risk factors and practiced with a non-pharmaceutical/non-surgical approach. Insurance claims and patient surveys were analyzed to compare clinical outcomes, costs and member satisfaction with a normative control group. During the 4-year study, this integrative medical approach, emphasizing a variety of complementary and alternative medical (CAM) therapies, resulted in lower patient costs and improved clinical outcomes for patients. The patients who went to DCs as their primary care providers had 43 percent decreases in hospital admissions, 52 percent reductions in pharmaceutical costs and 43 percent fewer outpatient surgeries and procedures.
Comparative Analysis Of Individuals With And Without Chiropractic Coverage. Legorreta A, Metz D, Nelson C, Ray S, Chernicoff H, DiNubile N. Archives of Internal Medicine 2004; 164: 1985-1992.
A 4-year retrospective review of claims from 1.7 million health plan members were analyzed to determine the cost effects of the inclusion of a chiropractic benefit in an HMO insurance plan. The data revealed that members with a chiropractic benefit had lower overall total annual health care costs. Back pain patients with chiropractic coverage also realized lower utilization of plain radiographs, low back surgery, hospitalizations and MRI’s. Back pain episode-related costs were also 25 percent lower for those with chiropractic
coverage ($289 vs. $399).
United Kingdom Back Pain, Exercise and Manipulation Randomized Trial: Cost Effectiveness of Physical Treatments for Back Pain In Primary Care. BMJ. 2004 Dec 11;329(7479):1381. Epub 2004 Nov 19.
This study compared the benefits of spinal manipulation and exercise to “best care” in general practice for patients consulting for back pain. 1,287 patients were divided into treatment groups and followed for more than one year. Patients receiving manipulation and exercise had lower relative treatment costs and experienced more treatment benefits than those treated with general medical care. The authors believe that this study convincingly demonstrated that manipulation alone and manipulation followed by exercise provided cost-effective additions to general practice.
Primary Care – Cost Effectiveness of Physiotherapy, Manual Therapy And General Practitioner Care For Neck Pain: Economic Evaluation Alongside A Randomized Controlled Trial. Korthals-de Bos I, Hoving J, Van Tulder M, Van Molken R, Ader H, De Vet H, Koes B, et al. British Medical Journal 2003; 326: 911.
Patients who received care from general practitioners for neck pain were randomly allocated to receive manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs). Throughout this 52-week study, patients rated their perceived recovery, intensity of pain and functional disability. Manual therapy proved to be the most effective treatment for neck pain. The clinical outcome measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. While achieving this superior outcome, the total costs of the manual therapy-treated patients were about one third of the costs of physiotherapy or general practitioner care.
Utilization, Cost, and Effects Of Chiropractic Care On Medicare Program Costs. Muse and Associates. American Chiropractic Association 2001.
This study examines cost, utilization and effects of chiropractic services on Medicare costs. The study compared program payments and service utilization for Medicare beneficiaries who visited DCs and those who visited other types of physicians. The results indicated that chiropractic care could reduce Medicare costs. Medicare beneficiaries who had chiropractic care had an average Medicare payment of $4,426 for all Medicare services. Those who had other types of care had an average of $8,103 Medicare payment for all Medicare services. The per claim average payment was also lower with chiropractic patients, having an average of $133 per claim compared to $210 per claim for individuals who did not have chiropractic care.
Costs And Recurrences Of Chiropractic And Medical Episodes Of Low Back Care. Smith, M; Stano, M. Journal of Manipulative and Physiological Therapeutics 1997; 20(1): 5-12.
This study compared the health insurance payments and patient utilization patterns of individuals suffering from recurring low back pain who visited Doctor of Chiropractic or medical doctors. Insurance payments were higher for medically initiated episodes. Those who visited chiropractors paid a lower cost and were also more satisfied with the care given. Because of this, the study suggests that chiropractic care should be given careful attention by employers when using gate-keeper strategies.
State Specific Workers Compensation Studies Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas. Executive Summary. MGT of America Feb 2003.
This retrospective study of workers’ compensation claims from 1996 to 2001 was conducted to determine the use and efficacy of chiropractic care in Texas. The researchers reviewed 900,000 claims during that time period to determine if chiropractic was cost-effective compared to medical treatment. They found that chiropractor treatment costs were the lowest of all providers. The study data demonstrated that increased utilization of chiropractic care could lead to declining costs relative to lower back injuries.
Giles L, Muller R. Chronic Spinal Pain – A Randomized Clinical Trial Comparing Medication, Acupuncture and Spinal Manipulation. Spine 2003; 28: 1490-1503. In this study, patients with chronic lower back pain of at least 13 weeks duration were randomly assigned either to medication, needle acupuncture or spinal manipulation. The results provided evidence that in patients with chronic spinal pain, manipulation results in greater short-term improvement than acupuncture or medication. The patients receiving spinal manipulation also reported a much higher full recovery rate (27%) than either those receiving acupuncture (9%) or medication (5%).
Wolsko P, Eisenberg D, Davis R, Kessler R, Phillips R. Patterns and Perceptions of Care for Treatment of Back and Neck Pain: Results of a National Survey. Spine 2003; 28(3): 292-298. Researchers conducted a national telephone survey of 2,055 adults, asking if they had back or neck problems during the past 12 months, and if yes, what type of treatment was received and how helpful was it. 33 percent of those surveyed reported having back or neck pain during the last year; 20 percent sought chiropractic care. Chiropractic providers were perceived as having been very helpful for back or neck pain in 61 percent of the cases, in contrast to only 27 percent who perceived their medical care as being very helpful. 72 percent of those treated by a chiropractor reported the treatment as very helpful, compared to only 19 percent of those who had seen conventional providers.
Hertzman-Miller R, Morgenstern H, Hurwitz E, et al. Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive Medical or Chiropractic Care: Results From the UCLA Low Back Pain Study. American Journal of Public Health 2002; 92: 1628-1633.
Approximately one third as many back pain patients seek chiropractic care compared to those who seek medical care. In earlier randomized clinical trials, investigators found spinal manipulation to have similar or better rates of patient satisfaction when compared to medical approaches such as physical therapy, McKenzie method and standard medical therapy. This study examined the differences in satisfaction between patients assigned to either medical care or chiropractic care in a managed care organization. In this randomized trial, the chiropractic patients were more satisfied with their back care after 4 weeks of treatment. The researchers concluded that providers in managed care organizations may be able to increase the satisfaction of their low back pain patients by communicating advice and information to patients about their condition and treatment.
Hoving J, Koes B, De Vet H, Van Der Windt D, Assendelft W, Van Mameren H, Deville W, Pool J, Scholten R, Bouter L. Manual Therapy, Physical Therapy or Continued Care by a General Practitioner for Patients with Neck Pain. Annals of Internal Medicine 2002; 136: 713-7220.
In a randomized, controlled trial, researchers compared the effectiveness of manual therapy, physical therapy (PT) and continued care by a general practitioner (GP) in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) compared to the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Additionally, patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care. The magnitude of the differences between manual therapy and the other treatments (PT or GP) was most pronounced for perceived recovery.
Nilsson N, Christensen HW, Harvigsen J. The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache. Journal of Manipulative and Physiological Therapeutics 1997; 20(5): 326-330.
Of 53 individuals who were diagnosed with cervicogenic headaches, 28 individuals in the group received high-speed, low-amplitude spinal manipulation in the cervical spine two times a week for three weeks. The rest of the group received low-level laser to the upper cervical region and deep-friction massage in the lower cervical/upper thoracic region two times a week for three weeks. For those who received spinal manipulation treatment, the amount of headache hours per day decreased 69 percent; for those receiving laser treatment, the decrease was only 37 percent. Intensity of headache decreased 36 percent for those receiving manipulations and 17 percent for those receiving laser treatment. The 25 use of pain relievers went down 36 percent for those receiving manipulations and was unchanged for those receiving laser treatment.
Boline PD, Kassem K, Bronfort G, Nelson C, Anderson A. Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-Type Headaches: A Randomized Clinical Trial. Journal of Manipulative and Physiological Therapeutics 1995; 18(3): 148-154.
This study compared the effects of spinal manipulation and pharmaceutical treatments for chronic tension headaches. Four weeks following the cessation of treatment, the pharmaceutical group demonstrated no improvement from the baseline. In the spinal manipulation group, headache intensity dropped 32 percent; frequency dropped 42 percent; and there was an overall improvement of 16 percent in functional health status.
Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment. British Medical Journal 1990; 300(2): 1431-1437.
741 patients, who had neither been treated in the past month nor had contraindications to spinal manipulation, were treated either by Doctor of Chiropractic or with conventional hospital outpatient treatment for management of low back pain. Using the Oswestry scale, which quantifies pain, patients reported back on their improvement at six weeks, six months, one year and two years. At two years, chiropractic care resulted in a 7 percent benefit over hospital care.
Gemmell HA, Hayes BM. Patient Satisfaction with Chiropractic Physicians in an Independent Physicians Association. Journal of Manipulative and Physiological Therapeutics 2001; 24(9): 556-559.
In this study, 150 chiropractic patients were surveyed. Chiropractic care received excellent remarks by percentage, in the following categories: Time to Get an Appointment – 84.9 percent; Convenience of Office – 57.7 percent; Access to Office by Phone – 77.3 percent; Length of Wait – 75.7 percent; Time Spent with Provider – 74.3 percent; Explanation of Treatment – 72.8 percent; Skill of Provider – 83.3 percent; Personal Manner of the Chiropractor – 92.4 percent. The overall visit category was given the excellent response by 83.3 percent of those surveyed.
Resources provided by Smart Injury Doctors and:
American Chiropractic Association
1701 Clarendon Boulevard
Arlington, VA 22209
TEL. (703) 276.8800
FAX (703) 243-2593
Association of Chiropractic Colleges
4424 Montgomery Avenue, Suite 202
Bethesda, MD 20814
TEL. (301) 652-5066
FAX (301) 913-9146
Congress of Chiropractic State Associations
12531 E. Meadow Dr
Wichita, KS 67206
TEL. (316) 613-3386
FAX (316) 633 4455
International Chiropractors Association
1110 N. Glebe Road,
Arlington, VA 22201
TEL. (703) 528-5000