Background: Previous clinical trials have demonstrated the efficacy, safety, effectiveness and efficiency of neuroreflexotherapy (NRT) in the treatment of subacute and chronic non-specific low back pain. The goal of this study was to describe the implementation of this method into the Spanish National Health System, to assess the viability of the referral protocol, and to obtain the data required for planning the widespread use of this technology.
Method: A referral protocol was established and explained in a single clinical session in 18 health centers in Majorca (Spain). During this session, handouts of the referral protocol and a telephone number for questions were also given. After the session, the centers' physicians were authorized to refer their patients to a unit certified for NRT. Demand for this therapy, the applicability of the referral protocol, the appropriateness of referrals, and patient and physician satisfaction were quantified over a four-month period. Data were also collected on patients' clinical outcomes and on adverse effects of the treatment.
Results: Of the 208 physicians, 43 referred 97 patients. The mean rate of referral per 10,000 persons affiliated with each health center was 1.07 patients per month. The rate of appropriate referral was 91.8%, with no physician having to call for assistance. Most of the referred patients had chronic, intense pain, with a poor prognosis and considerable disability. None of the patients refused NRT. There were no complaints, or serious adverse effects. The degree of satisfaction was high, and 98% of patients and 87% of physicians would recommend a relative referral to. In addition, 89% of physicians believed they should be allowed to continue referring their patients. The patients' clinical outcomes were favorable and consistent with those observed in previous clinical trials.
Conclusions: The method described allows NRT to be included in routine clinical practice within the Spanish National Health System under the conditions in which it was evaluated in previous randomized controlled trials. The referral protocol that was used generates a high rate of appropriate referrals, a high degree of satisfaction among patients and physicians, and clinical results that are consistent with the effectiveness and safety previously demonstrated for this technology.