Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries.
Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries.
复制标题
DOI：
10.1097/brs.0000000000004118
复制
发表时间：
2022-02-15
期刊：
影响因子：
3
通讯作者：
Haldeman S
中科院分区：
文献类型：
--
作者：
Whedon JM;Kizhakkeveettil A;Toler AW;Bezdjian S;Rossi D;Uptmor S;MacKenzie TA;Lurie JD;Hurwitz EL;Coulter I;Haldeman S
我们结合了队列和交叉队列设计的元素。本研究的目的是比较脊柱推拿治疗（SMT）和阿片类镇痛治疗（OAT）对慢性腰痛（cLBP）患者的护理升级的长期结局。目前临床管理cLBP的循证指南包括OAT和SMT。对于老年人的长期护理，继续OAT或SMT的效率和价值是不确定的。我们研究了五年期间的医疗保险索赔数据。我们纳入了2013年开始发生cLBP的老年医疗保险受益人。所有患者均连续入组Medicare A、B和D部分。我们分析了表明cLBP护理升级的累积频率，包括住院、急诊科就诊、高级诊断成像、专家就诊、腰骶手术、介入疼痛医学技术和cLBP潜在并发症。与OAT相比，SMT与较低的护理升级率相关。初始选择OAT与初始选择SMT相比，调整后的升级护理就诊率约高2.5倍（加权倾向评分：率比2.67，95% CI 2.64-2.69，p < .0001）。在老年医疗保险受益人谁开始长期护理的cLBP与阿片类镇痛剂治疗，调整率的升级护理遇到显着高于那些谁开始护理与脊柱推拿治疗。
We combined elements of cohort and crossover-cohort design. The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP). Current evidence-based guidelines for clinical management of cLBP include both OAT and SMT. For long-term care of older adults, the efficiency and value of continuing either OAT or SMT are uncertain. We examined Medicare claims data spanning a five-year period. We included older Medicare beneficiaries with an episode of cLBP beginning in 2013. All patients were continuously enrolled under Medicare Parts A, B, and D. We analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP. SMT was associated with lower rates of escalation of care as compared to OAT. The adjusted rate of escalated care encounters was approximately 2.5 times higher for initial choice of OAT vs. initial choice of SMT (with weighted propensity scoring: rate ratio 2.67, 95% CI 2.64–2.69, p < .0001). Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy.