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. 2022 Jun 3;3:57. doi: 10.1186/s43058-022-00305-2

Table 4.

Reported additional interventions and associated costs by study

Author, Year Imaging Medication Procedural Interventions
Low back pain
 Childs, 2015 [22]

Adherent 17.0%

Nonadherent 22.7%

aOR = 0.72, (99% CI 0.69 to 0.76)

Early 11.9%

Delayed 21.0%

aOR = 0.52, (99% CI 0.50 to 0.54)

Prescription Medication Costs:

Adherent Care $886.27 (SE 19.82)

Nonadherent Care $1233.90 (SE 19.86)

Difference $347.63 (95% CI 292.63 to 402.63)

Early $772.20 (SE 13.00)

Delayed $762.74 (SE 12.44)

Opioid Medication Use:

Adherent 65.2%

Nonadherent 66.0%

Early 59.7%

Delayed 0.3%

aOR = 0.62, (99% CI 0.60 to 0.64)

Lumbar Spinal Injections:

Adherent 11.7%

Nonadherent 13.8%

aOR = 0.82, (99% CI 0.77 to 0.87)

Early 8.7%

Delayed14.6%

aOR = 0.56, (99% CI 0.53 to 0.59)

Lumbar Spine Surgery:

Adherent 2.6%

Nonadherent 3.0%

aOR = 0.85, (99% CI 0.75 to 0.96)

Early .9%

Delayed 3.2%

aOR = 0.59, (99% CI 0.54 to 0.65)

 Fritz, 2012 [16]

Opioid medication use

All 49.1%

Early 49.1%

Delayed 55.3% OR = 0.78, (95% CI 0.66 to 0.93)

Adherent 49.6%

Nonadherent 53.2%

Prescription Medication costs:

All 104.23 (SE 3.01)

Early $80.41 (SE 10.22)

Delayed $116.83 (SE 11.27)

Adherent $76.43 (SE 9.85)

Nonadherent $98.85 (SE 9.61)

Lumbar spine surgery

All 2.5%

Early 4.7%

Delayed 9.9% OR = 0.45, (95% CI 0.32 to 0.64)

Adherent 5.1%

Nonadherent 8.1% OR = 0.61; (95% CI 0.38 to 0.98)

Lumbar spinal injections

All 7.1%

Early 10.1%

Delayed 21.2% OR = 0.42 (95% CI 0.32 to 0.64)

Adherent 12.6%

Nonadherent 17.8% OR = 0.55, (95% CI 0.48 to 0.91)

Costs: Surgical/Injection Procedures:

All $740.44 (SE 36.84)

Early $1018.88 (170.65)

Delayed $2760.62 (SE 381.27)

Adherent $1445.23 (SE 486.37)

Nonadherent $1965.72 (SE 229.42)

 Hoeijenbos, 2005 [25]

Prescribed medicines:

Baseline 40%

12 weeks 10%

Not prescribed medicines:

Baseline 49%

12 weeks +/− 23%

Mean direct medical costs for the previous 6 weeks

Baseline: Intervention € 7 median € 1, Control € 7, median €10

6 weeks: Intervention € 4, median € 0, Control € 3, median € 0

12 weeks: Intervention € 1, median € 0, Control € 3, median € 0

26 weeks: Intervention € 3, median € 0, Control € 3, median € 0

52 weeks: Intervention € 3, median € 0, Control € 3, median € 0

Percentage utilizing and mean cost of prescribed medicines by doctor in previous 6 weeks:

Baseline: Intervention 41.5%, € 5.73, median € 0; Control 37.8%, € 5.29, median € 0

6 weeks: intervention 21.4%, € 3.42, median € 0; Control 20.8%, € 2.31, median € 0

12 weeks: Intervention 10.4%, € 1.19, median € 0, Control 10.8%, € 1.90, median € 0

26 weeks: Intervention 8.8%, € 2.67, median € 0, Control 8.7%, € 1.87, median € 0

52 weeks: Intervention 11.7%, € 2.20, median € 0, Control 9.9%, € 2.19, median € 0

Percentage utilizing and mean cost nonprescription medications in previous 6 weeks:

Baseline: Intervention 49.0%, € 1.63, median € 0; Control 49.0%, € 1.88, median € 0

6 weeks: intervention 30.8%, € 0.77, median € 0; Control 38.5%, € 1.16, median € 0

12 weeks: Intervention 23.5%, € 0.46, median € 0, Control 22.1%, € 0.79, median € 0

26 weeks: Intervention 20.5%, € 0.24, median € 0, Control 18.3%, € 0.61, median € 0

52 weeks: Intervention 23.4%, € 0.78, median € 0, Control 20.3%, € 0.59, median € 0

Bolded indicates significant difference from previous measure

 Magel, 2018 [34]

Radiographs:

All patients 214 (53.5%)

Participants 32 (25.8%)

Nonparticipants 182 (65.9%)

Refused 71 (70.3%)

Not offered 111 (63.4%)

Advanced Imaging:

All patients 85 (21.3%)

Participants 11 (8.9%)

Nonparticipants 79 (27.2%)

Refused 26 (25.7%)

Not offered 53 (28.5%)

Participants were less likely to have lumbar radiographs and advanced imaging over the 6-month follow period compared to nonparticipants P< .05

Epidural steroid injections: All patients 90 (22.5%), Participants 10 (8.1%), Nonparticipants 80 (29.0%), Refused 30 (29.7%), Not offered 50 (28.6%)

Spinal surgical procedure: All patients 9 (2.3%), Participants 2 (1.6%), Nonparticipants 7 (2.5%), Refused 2 (2.0%), Not offered 5 (2.8%)

Participants were less likely to have epidural injections over the 6 month follow period compared to nonparticipants P< .05

 Sharma, 2019 [26]

Number of NSAIDs per week used at follow-up:

Pain Education 2

Control 5

Acute low back pain
 Fritz, 2008 [18]

Use of diagnostic procedures:

Adherent 14.4%,

Nonadherent 23.6%; aOR = 0.53, (95% CI 0.31 to 0.92); P<.05.

Use of MRI:

Adherent 8.3%,

Nonadherent 15.9%; aOR = 0.47, (95% CI 0.24 to 0.94); P<.05

Use of prescription medication:

Adherent 46.2%,

Nonadherent 57.2%, aOR = 0.64 (95% CI 0.43 to 0.97); P< .05

Use of skeletal muscle relaxants:

Adherent 16.7%,

Nonadherent 25.4%, aOR = 0.59, (95% CI 0.35 to 0.99); P< .05

Injection procedures:

Adherent 9.1%,

Nonadherent 15.9%; aOR = 0.40, (95% CI 0.18 to 0.85); P< .05

Epidural injection with fluoroscopy:

Adherent 5.3%,

Nonadherent 12.1%; aOR = 0.40, (95% CI 0.18 to 0.94); P< .05

Chronic low back pain
 Van der Roer, 2008 [24]

X-ray:

Protocol 0.2 (SD 0.8), 9.1%

Guideline 0.3 (SD 1.0), 10.6%

MRI:

Protocol 0.2 (SD 0.6), 7.3%

Guideline 0 (SD 0.3), 2.1%

CT-scan:

Protocol 0 (SD 0), 0%

Guideline 0 (SD 0), 2.1%

Medication (% yes):

Protocol 56.7%

Guideline 55.6%

Medication Costs:

Protocol € 12 (SD 23)

Guideline € 13 (SD 24)

Mean Difference € −1, (95% CI −11 to 8)

Low back pain with radicular symptoms
 Hahne, 2017 [27]

No significant differences aside from proportion taking Paracetamol at 12 months

Intervention 2/28 (7%)

Control 7/25 (28%)

Risk difference −21%, 95% CI −41 to −0.2%

No participants underwent surgery

Epidural injection:

Intervention 2

Control 1

Medial Branch Block:

Intervention 0

Control 1

Neck pain
 Horn, 2016 [19] Adherent care: had 43% fewer diagnostic images. adjusted mean difference = 0.43 images, IRR = 0.57, 95% CI 0.36 to 0.90; P= 0.02 Adherent care: 25% fewer prescription medications. adjusted mean difference = 1.00 prescription; IRR = 0.75, 95% CI 0.59 to 0.95; P= .02

Bolded indicates statistical significance

PT physical therapy, SE standard error, SD standard deviation, aOR adjusted odds ratio

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