Spinal Manipulative Therapy vs. Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain
Spinal Manipulative Therapy vs. Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain
批准号:
10512448
负责人:
James M. Whedon
金额:
$45.96万
依托单位国家:
美国
项目类别:
财政年份:
2018
资助国家:
美国
项目状态:
已结题
起止时间:
2018-08-01 至 2024-08-31
关键词:
Absence of pain sensationAcuteAdoptionAdultAdverse drug eventAdverse eventAffectAnalgesicsArteriesCaliforniaCardiovascular systemCaringCervicalCervical spinal cord injuryChargeChronicClinicalClinical TrialsComplementary HealthCost MeasuresCost SharingDataDiagnosisDissectionDrug PrescriptionsEffectivenessElderlyEmergency department visitEnvironmentEventExpenditureFosteringFundingGoalsHealth ExpendituresHealth SciencesHealth Services ResearchHealthcareHemorrhageHospitalizationImageInstitutionInsurance CarriersInsurance Claim ReviewIntegrative MedicineInterventionIntervention StudiesKidney FailureLiteratureMeasuresMedicalMedicareMedicare claimMethodologyMethodsMissionModelingNational Center for Complementary and Integrative HealthNatureNeck PainNon-Steroidal Anti-Inflammatory AgentsOperative Surgical ProceduresOpioidOutcomeOutpatientsPain managementPathway interactionsPatientsPharmacotherapyPrescription drug overdosePrevalencePublic HealthReportingResearchResearch PersonnelResearch Project GrantsRetrospective cohortRiskSafetySamplingSelection BiasSerious Adverse EventSourceSpecialistSpinal InjectionsSpinal InjuriesSpinal ManipulationSpine painStrokeStudentsSubstance Use DisorderSymptomsTestingTrainingUnited StatesUnited States National Institutes of HealthUniversitiesVertebral columnVisitWeightadverse outcomeagedalternative treatmentbeneficiarycareerchronic pain managementcomorbiditycomparativecostdesigndisabilityevidence baseexpectationgastrointestinalhands on researchhazardhigh riskimprovedinnovationinterdisciplinary collaborationintervention costpain symptompreservationpsychologicsocialstudent participationsystematic reviewtherapy designtreatment strategy
中文摘要
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
英文摘要
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.
期刊论文(3)
专著(0)
科研奖励(0)
会议论文
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
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
Utilization and Safety of Chiropractic Care in Older Adults
-
批准号:7639911
-
项目类别:
-
资助金额:$10.5万
-
财政年份:2009
-
负责人:James M. Whedon
-
依托单位:
Utilization and Safety of Chiropractic Care in Older Adults
-
批准号:8238129
-
项目类别:
-
资助金额:$12.08万
-
财政年份:2009
-
负责人:James M. Whedon
-
依托单位:
Utilization and Safety of Chiropractic Care in Older Adults
-
批准号:8044189
-
项目类别:
-
资助金额:$11.42万
-
财政年份:2009
-
负责人:James M. Whedon
-
依托单位:
Utilization and Safety of Chiropractic Care in Older Adults
-
批准号:7781367
-
项目类别:
-
资助金额:$10.95万
-
财政年份:2009
-
负责人:James M. Whedon
-
依托单位:
Utilization and Safety of Chiropractic Care in Older Adults
-
批准号:8443744
-
项目类别:
-
资助金额:$12.61万
-
财政年份:2009
-
负责人:James M. Whedon
-
依托单位:
海外基金