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The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain.
- Source :
-
BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2019 Nov 07; Vol. 20 (1), pp. 519. Date of Electronic Publication: 2019 Nov 07. - Publication Year :
- 2019
-
Abstract
- Background: Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective-i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered.<br />Methods: We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain.<br />Results: The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate.<br />Conclusions: This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials.
- Subjects :
- Chronic Pain economics
Chronic Pain psychology
Cost-Benefit Analysis methods
Cost-Benefit Analysis standards
Health Care Costs
Humans
Low Back Pain economics
Low Back Pain psychology
Manipulation, Spinal psychology
Manipulation, Spinal standards
Neck Pain economics
Neck Pain psychology
Regional Health Planning methods
Regional Health Planning standards
Chronic Pain rehabilitation
Low Back Pain rehabilitation
Manipulation, Spinal economics
Neck Pain rehabilitation
Patient Preference
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2474
- Volume :
- 20
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC musculoskeletal disorders
- Publication Type :
- Academic Journal
- Accession number :
- 31699077
- Full Text :
- https://doi.org/10.1186/s12891-019-2904-6