Table 4.
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