Positive Health Online

Abstract

HEMMILA, Folk Medicine Centre, Kaustinen, Finland, E: heikki.hemmila@pp.fimnet.fi, investigated quality of life, healthcare costs and use and effects of various therapies in patients with chronic back pain .

Background

Chronic back pain has mainly been highlighted only in the relatively small proportion of patients whose conditions require high-cost treatment and present a significant burden on healthcare resources. Many patients who suffer back pain receive little publicity, as their treatments are comparatively low cost. There has been little evaluation of patients' choices of therapy, particularly alternative/complementary therapies.

Methodology

Study subjects were 114 Finnish patients being treated by their GPs for chronic back pain. They were studied for 1 year before and for 1 year after they entered a randomized clinical trial. Data were obtained – from the Social Insurance Institution files, patients' records and questionnaires (the Nottingham Health Profile; NHP) – on therapy use, costs to society and patients' quality of life. Effects of physiotherapy, bone setting and light exercise therapy on these measures were also explored.

Results

1 year before they entered the clinical trial, a third of patients had consulted their GP . 50% of the patients had undergone some form of therapy, the main ones being massage, physiotherapy, naprapathy or bone setting . Complementary therapies accounted for one third of direct costs, and rehabilitation for another third . 55% of the total costs (US$1029) were due to sick leave . After the patients received the randomized therapies, mean total costs increased slightly (US$1306). Costs of ambulatory care were similar [to the mean total costs]. Physiotherapy appeared to be the least expensive therapy (US$621), and bone setting the most expensive (US$2072). Physiotherapy and bone setting both resulted in improvements on more subscales on the NHP in comparison with exercise .

Conclusion

Complementary therapies accounted for one third of the direct costs of back pain . After a course of physiotherapy, patients tended to use healthcare services less and take less sick leave . Quality of life of patients with chronic back pain seemed to be improved by physiotherapy and bone setting .

References

Hemmila HM. Quality of life and cost of care of back pain patients in Finnish general practice. Spine 27 (6): 647-53. Mar 2002.