Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain: The SPINE CARE Randomized Clinical Trial.

Autor:	Choudhry NK; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Fifer S; Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, California., Fontanet CP; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Archer KR; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee., Sears E; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Bhatkhande G; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Haff N; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Ghazinouri R; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Coronado RA; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee., Schneider BJ; Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee., Butterworth SW; Center for Health System Improvement, University of Tennessee Health Science Center, Memphis., Deogun H; HonorHealth Clinical Research Institute, Scottsdale, Arizona., Cooper A; HonorHealth Clinical Research Institute, Scottsdale, Arizona., Hsu E; Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, California., Block S; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee., Davidson CA; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Shackelford CE; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Goyal P; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Milstein A; Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, California., Crum K; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Scott J; Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, California., Marton K; Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, California., Silva FM; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Obeidalla S; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Robinette PE; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Lorenzana-DeWitt M; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Bair CA; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Sadun HJ; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Goldfield N; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Hogewood LM; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Sterling EK; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Pickney C; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Koltun-Baker EJ; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Swehla A; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Ravikumar V; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Malhotra S; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee., Finney ST; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Holliday L; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Moolman KC; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Coleman-Dockery S; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Patel IB; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Angel FB; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Green JK; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Mitchell K; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., McBean MR; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Ghaffar M; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Ermini SR; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Carr AL; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., MacDonald J; Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2022 Dec 20; Vol. 328 (23), pp. 2334-2344.
DOI:	10.1001/jama.2022.22625
Abstrakt:	Importance: Low back and neck pain are often self-limited, but health care spending remains high. Objective: To evaluate the effects of 2 interventions that emphasize noninvasive care for spine pain. Design, Setting, and Participants: Pragmatic, cluster, randomized clinical trial conducted at 33 centers in the US that enrolled 2971 participants with neck or back pain of 3 months' duration or less (enrollment, June 2017 to March 2020; final follow-up, March 2021). Interventions: Participants were randomized at the clinic-level to (1) usual care (n = 992); (2) a risk-stratified, multidisciplinary intervention (the identify, coordinate, and enhance [ICE] care model that combines physical therapy, health coach counseling, and consultation from a specialist in pain medicine or rehabilitation) (n = 829); or (3) individualized postural therapy (IPT), a postural therapy approach that combines physical therapy with building self-efficacy and self-management (n = 1150). Main Outcomes and Measures: The primary outcomes were change in Oswestry Disability Index (ODI) score at 3 months (range, 0 [best] to 100 [worst]; minimal clinically important difference, 6) and spine-related health care spending at 1 year. A 2-sided significance threshold of .025 was used to define statistical significance. Results: Among 2971 participants randomized (mean age, 51.7 years; 1792 women [60.3%]), 2733 (92%) finished the trial. Between baseline and 3-month follow-up, mean ODI scores changed from 31.2 to 15.4 for ICE, from 29.3 to 15.4 for IPT, and from 28.9 to 19.5 for usual care. At 3-month follow-up, absolute differences compared with usual care were -5.8 (95% CI, -7.7 to -3.9; P < .001) for ICE and -4.3 (95% CI, -5.9 to -2.6; P < .001) for IPT. Mean 12-month spending was $1448, $2528, and $1587 in the ICE, IPT, and usual care groups, respectively. Differences in spending compared with usual care were -$139 (risk ratio, 0.93 [95% CI, 0.87 to 0.997]; P = .04) for ICE and $941 (risk ratio, 1.40 [95% CI, 1.35 to 1.45]; P < .001) for IPT. Conclusions and Relevance: Among patients with acute or subacute spine pain, a multidisciplinary biopsychosocial intervention or an individualized postural therapy intervention, each compared with usual care, resulted in small but statistically significant reductions in pain-related disability at 3 months. However, compared with usual care, the biopsychosocial intervention resulted in no significant difference in spine-related health care spending and the postural therapy intervention resulted in significantly greater spine-related health care spending at 1 year. Trial Registration: ClinicalTrials.gov Identifier: NCT03083886.
Databáze:	MEDLINE
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