Symptomatic Magnetic Resonance Imaging–Confirmed Lumbar Disk Herniation Patients: A Comparative Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either High-Velocity, Low-Amplitude Spinal Manipulative Therapy or Imaging-Guided Lumbar Nerve Root Injections
Autor: | B. Kim Humphreys, Juerg Hodler, Cynthia K. Peterson, Marco Lechmann, Christian W. A. Pfirrmann, Serafin Leemann |
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Přispěvatelé: | University of Zurich, Peterson, Cynthia K |
Rok vydání: | 2013 |
Předmět: |
Adult
Male Manipulation Spinal Time Factors Cost-Benefit Analysis Injections Epidural 610 Medicine & health Spinal manipulation Risk Assessment Severity of Illness Index Patient Positioning Cohort Studies Lumbar Humans Medicine Prospective Studies Prospective cohort study Aged Pain Measurement Analgesics Lumbar Vertebrae medicine.diagnostic_test 10042 Clinic for Diagnostic and Interventional Radiology business.industry Magnetic resonance imaging Middle Aged Chiropractic Magnetic Resonance Imaging Low back pain Confidence interval 3602 Chiropractics Treatment Outcome Patient Satisfaction Case-Control Studies Anesthesia 10046 Balgrist University Hospital Swiss Spinal Cord Injury Center Female Chiropractics Manual therapy medicine.symptom Spinal Nerve Roots business Low Back Pain Intervertebral Disc Displacement Follow-Up Studies |
Zdroj: | Journal of Manipulative and Physiological Therapeutics. 36:218-225 |
ISSN: | 0161-4754 |
Popis: | Objectives The purpose of this study was to compare self-reported pain and “improvement” of patients with symptomatic, magnetic resonance imaging–confirmed, lumbar disk herniations treated with either high-velocity, low-amplitude spinal manipulative therapy (SMT) or nerve root injections (NRI). Methods This prospective cohort comparative effectiveness study included 102 age- and sex-matched patients treated with either NRI or SMT. Numerical rating scale (NRS) pain data were collected before treatment. One month after treatment, current NRS pain levels and overall improvement assessed using the Patient Global Impression of Change scale were recorded. The proportion of patients, “improved” or “worse,” was calculated for each treatment. Comparison of pretreatment and 1-month NRS scores used the paired t test. Numerical rating scale and NRS change scores for the 2 groups were compared using the unpaired t test. The groups were also compared for “improvement” using the χ 2 test. Odds ratios with 95% confidence intervals were calculated. Average direct procedure costs for each treatment were calculated. Results No significant differences for self-reported pain or improvement were found between the 2 groups. “Improvement” was reported in 76.5% of SMT patients and in 62.7% of the NRI group. Both groups reported significantly reduced NRS scores at 1 month ( P = .0001). Average cost for treatment with SMT was Swiss Francs 533.77 (US $558.75) and Swiss Francs 697 (US $729.61) for NRI. Conclusions Most SMT and NRI patients with radicular low back pain and magnetic resonance imaging–confirmed disk herniation matching symptomatic presentation reported significant and clinically relevant reduction in self-reported pain level and increased global perception of improvement. There were no significant differences in outcomes between NRI and SMT. When considering direct procedure costs, the average cost of SMT was slightly less expensive. |
Databáze: | OpenAIRE |
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