Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials

Alexander Tsertsvadze; Christine Clar; Rachel Court; Aileen Clarke; Hema Mistry; Paul Sutcliffe

doi:10.1016/j.jmpt.2014.05.001

Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials

J Manipulative Physiol Ther. 2014 Jul-Aug;37(6):343-62. doi: 10.1016/j.jmpt.2014.05.001. Epub 2014 Jun 27.

Authors

Alexander Tsertsvadze¹, Christine Clar¹, Rachel Court², Aileen Clarke³, Hema Mistry⁴, Paul Sutcliffe⁵

Affiliations

¹ Senior Research Fellow, Warwick Medical School, University of Warwick, Coventry, UK.
² Information Specialist, Warwick Medical School, University of Warwick, Coventry, UK.
³ Professor, Warwick Medical School, University of Warwick, Coventry, UK.
⁴ Assistant Professor, Warwick Medical School, University of Warwick, Coventry, UK.
⁵ Associate Professor, Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: p.a.sutcliffe@warwick.ac.uk.

PMID: 24986566
DOI: 10.1016/j.jmpt.2014.05.001

Abstract

Objectives: The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

Methods: A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

Results: Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

Conclusions: Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.

Keywords: Back Pain; Chiropractic; Cost-Effectiveness; Cost-Utility; Manual Therapy; Systematic Review.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Cost-Benefit Analysis
Humans
Low Back Pain / therapy
Musculoskeletal Diseases / economics*
Musculoskeletal Diseases / therapy*
Neck Pain / therapy
Physical Therapy Modalities / economics*
Randomized Controlled Trials as Topic

Grants and funding

WMCLAHRC-2014-1/DH_/Department of Health/United Kingdom