Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back painâ•firelated health care costs

BACKGROUND CONTEXT: Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care–seeking for LBP. PURPOSE: The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. STUDY DESIGN/SETTING: The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n54,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. METHODS: In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. RESULTS: After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p5.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, FDA drug/device status: Not applicable. Author disclosures: JDC: Grant: Department of Defense CDMRP (F, Paid directly to institution); Stock Ownership: Evidence in Motion (unknown shares, 20% ownership), Texas Physical Therapy Specialists (unknown shares, 25% ownership). SSW: Grant: Department of Defense (D, Paid directly to institution); Support for travel to meetings for the study or other purposes: Department of Defense (A, Paid directly to institution). DST: Grant: Department of Defense CDMRP (H, Paid directly to institution). MER: Grant: Department of Defense (unknown amount, Paid directly to institution). SZG: Grant: Department of Defense (E, Paid directly to institution); Support for travel to meetings for the study or other purposes: Department of Defense (B, Paid directly to institution); Scientific Advisory Board: American Physical Therapy Association (B); Other Office: American Physical Therapy Association (B). The disclosure key can be found on the Table of