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
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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