Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care.

نویسندگان

  • Nefyn H Williams
  • Clare Wilkinson
  • Ian Russell
  • Rhiannon T Edwards
  • Richard Hibbs
  • Pat Linck
  • Rachel Muntz
چکیده

BACKGROUND Spinal pain is common and frequently disabling. Management guidelines have encouraged referral from primary care for spinal manipulation. However, the evidence base for these recommendations is weak. More pragmatic trials and economic evaluations have been recommended. OBJECTIVES Our aim was to assess the effectiveness and health care costs of a practice-based osteopathy clinic for subacute spinal pain. METHODS A pragmatic randomized controlled trial was carried out in a primary care osteopathy clinic accepting referrals from 14 neighbouring practices in North West Wales. A total of 201 patients with neck or back pain of 2-12 weeks duration were allocated at random between usual GP care and an additional three sessions of osteopathic spinal manipulation. The primary outcome measure was the Extended Aberdeen Spine Pain Scale (EASPS). Secondary measures included SF-12, EuroQol and Short-form McGill Pain Questionnaire. Health care costs were estimated from the records of referring GPs. RESULTS Outcomes improved more in the osteopathy group than the usual care group. At 2 months, this improvement was significantly greater in EASPS [95% confidence interval (CI) 0.7-9.8] and SF-12 mental score (95% CI 2.7-10.7). At 6 months, this difference was no longer significant for EASPS (95% CI -1.5 to 10.4), but remained significant for SF-12 mental score (95% CI 1.0-9.9). Mean health care costs attributed to spinal pain were significantly greater by 65 UK pounds in the osteopathy group (95% CI 32-155 UK pounds). Though osteopathy also cost 22 UK pounds more in mean total health care cost, this was not significant (95% CI - 159 to 142 UK pounds). CONCLUSION A primary care osteopathy clinic improved short-term physical and longer term psychological outcomes, at little extra cost. Rigorous multicentre studies are now needed to assess the generalizability of this approach.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

OSTEOPAThic Health outcomes In Chronic low back pain: The OSTEOPATHIC Trial

BACKGROUND Osteopathic manipulative treatment (OMT) and ultrasound physical therapy (UPT) are commonly used for chronic low back pain. Although there is evidence from a systematic review and meta-analysis that OMT generally reduces low back pain, there are no large clinical trials that specifically assess OMT efficacy in chronic low back pain. Similarly, there is a lack of evidence involving UP...

متن کامل

Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial.

BACKGROUND Spinal pain is common and costly to health services and society. Management guidelines have encouraged primary care referral for spinal manipulation, but the evidence base is weak. More economic evaluations alongside pragmatic trials have been recommended. OBJECTIVE Our aim was to assess the cost-utility of a practice-based osteopathy clinic for subacute spinal pain. METHODS A co...

متن کامل

A comparison of osteopathic spinal manipulation with standard care for patients with low back pain.

BACKGROUND The effect of osteopathic manual therapy (i.e., spinal manipulation) in patients with chronic and subchronic back pain is largely unknown, and its use in such patients is controversial. Nevertheless, manual therapy is a frequently used method of treatment in this group of patients. METHODS We performed a randomized, controlled trial that involved patients who had had back pain for ...

متن کامل

Time for the osteopathic profession to take the lead in musculoskeletal research

Musculoskeletal conditions, such as low back pain, are prevalent in the United States. These conditions exact an enormous toll on society, both in terms of their detrimental impact on quality of life and on the costs of treatment and lost productivity. Osteopathic physicians, as common providers of primary care services and spinal manipulation, are ideally positioned to lead future research eff...

متن کامل

The Reliability of Chiropractic Methods Used for the Detection of Spinal Subluxation

The study by Meade et al (2) in the UK compared chiropractic treatment with hospital out-patient treatment for the management of low back pain. This was a pragmatic randomised controlled trial in which the authors concluded that chiropractic treatment was more effective than hospital out-patient management which consisted mainly of physiotherapy. A difficulty with the trial is that it was not “...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Family practice

دوره 20 6  شماره 

صفحات  -

تاریخ انتشار 2003