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Spinal Manipulative Therapy vs. Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain

脊柱手法治疗与处方药治疗对患有颈部疼痛的老年医疗保险受益人的护理

基本信息

批准号：
10512448
负责人：
James M. Whedon
金额：
$ 45.96万
依托单位：
SOUTHERN CALIFORNIA UNIV OF HEALTH SCIS
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10512448
关键词：
Absence of pain sensation Acute Adoption Adult Adverse drug event Adverse event Affect Analgesics Arteries California Cardiovascular system Caring Cervical Cervical spinal cord injury Charge Chronic Clinical Clinical Trials Complementary Health Cost Measures Cost Sharing Data Diagnosis Dissection Drug Prescriptions Effectiveness Elderly Emergency department visit Environment Event Expenditure Fostering Funding Goals Health Expenditures Health Sciences Health Services Research Healthcare Hemorrhage Hospitalization Image Institution Insurance Carriers Insurance Claim Review Integrative Medicine Intervention Intervention Studies Kidney Failure Literature Measures Medical Medicare Medicare claim Methodology Methods Mission Modeling National Center for Complementary and Integrative Health Nature Neck Pain Non-Steroidal Anti-Inflammatory Agents Operative Surgical Procedures Opioid Outcome Outpatients Pain management Pathway interactions Patients Pharmacotherapy Prescription drug overdose Prevalence Public Health Reporting Research Research Personnel Research Project Grants Retrospective cohort Risk Safety Sampling Selection Bias Serious Adverse Event Source Specialist Spinal Injections Spinal Injuries Spinal Manipulation Spine pain Stroke Students Substance Use Disorder Symptoms Testing Training United States United States National Institutes of Health Universities Vertebral column Visit Weight adverse outcome aged alternative treatment beneficiary career chronic pain management comorbidity comparative cost design disability evidence base expectation gastrointestinal hands on research hazard high risk improved innovation interdisciplinary collaboration intervention cost pain symptom preservation psychologic social student participation systematic review therapy design treatment strategy

项目摘要

An estimated 3.9 million older US adults suffer from Neck Pain (NP), the fourth leading cause of disability worldwide. However, little is known about the comparative value of current treatment approaches to NP. The management of spine pain in the United States is inefficient, costly, and sometimes hazardous. Thus, there is an acute need to evaluate non-pharmaceutical treatment alternatives and identify safe, high-value management strategies. The need is critical for older adults with NP, who tend to be comorbid, vulnerable to adverse events, and prone to the utilization of high-cost interventions. Prescription drug therapy (PDT) and spinal manipulative therapy (SMT) are widely used treatment strategies for NP, but their comparative value for NP is uncertain. Because NP is often persistent, many patients feel compelled to seek ongoing care, but the chronic use of PDT (primarily opioids and NSAIDs) for NP raises safety concerns, particularly for the elderly. The utilization of SMT - which shows similar effectiveness to other interventions in systematic reviews - is often limited by insurers because the value of prolonged treatment is also uncertain. There is, therefore, a pressing need to compare the long-term value of these two approaches (SMT and PDT) for management of NP in Medicare beneficiaries. The overall objective of this project is to assess both short- and long-term value of SMT as compared to PDT for management of NP in older Medicare beneficiaries. With active engagement of students, this project is also intended to strengthen the research environment at Southern California University of Health Sciences. The central hypothesis is that utilization of SMT for NP offers superior value as compared to PDT. The central hypothesis will be tested objectively by pursuing three related but independent specific aims: (1) compare the short- and long-term safety of SMT vs. PDT as measured by the likelihood of adverse outcomes, (2) compare the short- and long-term efficiency of SMT vs. PDT as measured by rates of escalation of care for NP, and (3) compare the short- and long-term costs of SMT vs. PDT as measured by payer expenditures and patient cost sharing. Rigorous methods intended to reduce risk of bias and confounding will include weighted propensity scoring and instrumental variable methodology. The approach to this research is innovative because relatively little is known about the value of non-pharmacological treatment approaches for NP among older adults. This project promises to challenge the status quo by assessing the value of a non- pharmacologic alternative to high-risk prescription drugs. Evidence of the superior value of SMT for care of NP will facilitate an innovative shift away from the hazards of chronic analgesic use and toward non- pharmacological interventions. The project also includes a practical plan for introducing large-scale health services research – with student participation - to two educational institutions that train complementary and integrative healthcare clinicians. The research contribution is expected to be significant because evidence favoring SMT promises to improve the safety, efficiency, and value of care for older adults with NP.

据估计，美国有390万老年人患有颈痛（NP），这是导致残疾的第四大原因

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries.

DOI：
10.1097/brs.0000000000004078
发表时间：
2021-12-15
期刊：
Spine
影响因子：
3
作者：
Whedon JM;Kizhakkeveettil A;Toler AW;MacKenzie TA;Lurie JD;Hurwitz EL;Bezdjian S;Bangash M;Uptmor S;Rossi D;Haldeman S
通讯作者：
Haldeman S

Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries.

脊柱手法治疗与处方药治疗慢性腰痛：老年医疗保险受益人的信念、护理满意度和生活质量。

DOI：
10.1016/j.jmpt.2021.12.007
发表时间：
2021
期刊：
Journal of manipulative and physiological therapeutics
影响因子：
1.3
作者：
Kizhakkeveettil,Anupama;Bezdjian,Serena;Hurwitz,EricL;Toler,AndrewWJ;Rossi,Daniel;Uptmor,Sarah;Sagester,Kayla;Bangash,Maria;MacKenzie,ToddA;Lurie,JohnD;Coulter,Ian;Haldeman,Scott;Whedon,JamesM
通讯作者：
Whedon,JamesM

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults.

DOI：
10.1016/j.jmpt.2021.09.001
发表时间：
2021-09
期刊：
Journal of manipulative and physiological therapeutics
影响因子：
1.3
作者：
Whedon JM;Kizhakkeveettil A;Toler A;MacKenzie TA;Lurie JD;Bezdjian S;Haldeman S;Hurwitz E;Coulter I
通讯作者：
Coulter I