Study design: A cohort of 114 primary care patients were studied for 1 year before and 1 year after a randomized clinical trial.
Objectives: To explore the therapy use, societal costs, and quality of life of patients with prolonged back pain. To compare the effects of physiotherapy, bone setting, and light exercise therapy on these measures.
Summary of background data: Analyses of back pain have mostly focused on the minority of patients who cause high costs and a heavy burden on national economies. The majority with low costs have aroused less interest. The patient's choice of therapy, especially alternative medicine, has seldom been evaluated despite the increasing popularity of alternative therapies.
Methods: Data were collected from the Social Insurance Institution files, patient records, and questionnaires: the Nottingham Health Profile (NHP).
Results: One year before enrollment a third of the patients had consulted primary care. Half of them had had some therapy: mainly massage, physiotherapy, naprapathy, or bone setting. One third of the direct costs were spent on complementary therapies and another third on rehabilitation. Sick leaves accounted for 55% of the total costs (US$ 1029). The mean total costs slightly increased after the randomized therapies (US$ 1306). The costs of ambulatory care, with the study therapies included, were similar, whereas physiotherapy seemed the cheapest (US$ 621) and bone setting the most expensive (US$ 2072) alternative in view of the total costs. More NHP subscales were improved by physiotherapy and bone setting than by exercise.
Conclusions: A third of the direct back pain costs were spent on complementary therapies. The use of health care services and absenteeism tended to decrease after a course of physiotherapy. Physiotherapy and bone setting seemed able to improve the quality of life of patients with prolonged back pain.