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

• 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
• 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

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，有 390 万美国老年人患有颈部疼痛 (NP)，这是导致残疾的第四大原因 全世界。然而，目前对 NP 治疗方法的比较价值知之甚少。这 在美国，脊柱疼痛的治疗效率低下、成本高昂，有时甚至是危险的。因此，有 迫切需要评估非药物治疗替代方案并确定安全、高价值的治疗方案 管理策略。对于患有 NP 的老年人来说，这一需求至关重要，他们往往患有共病，容易受到 不良事件，并且容易采用高成本的干预措施。处方药治疗 (PDT) 和 脊柱手法治疗 (SMT) 是广泛使用的 NP 治疗策略，但其相对价值 NP 不确定。由于 NP 常常持续存在，许多患者感到必须寻求持续治疗，但 长期使用 PDT（主要是阿片类药物和非甾体抗炎药）治疗 NP 会引起安全问题，特别是对于老年人而言。 SMT 的使用——在系统评价中显示出与其他干预措施相似的有效性——通常是 受到保险公司的限制，因为长期治疗的价值也不确定。因此，迫切需要 需要比较这两种方法（SMT 和 PDT）对于 NP 管理的长期价值 医疗保险受益人。该项目的总体目标是评估短期和长期价值 SMT 与 PDT 在老年医疗保险受益人 NP 管理方面的比较。通过积极参与 学生们，这个项目还旨在加强南加州大学的研究环境 健康科学。核心假设是，相比之下，利用 SMT 进行 NP 具有更高的价值 到PDT。中心假设将通过追求三个相关但独立的具体目标来进行客观检验 目标：(1) 通过不良反应的可能性来衡量 SMT 与 PDT 的短期和长期安全性 结果，(2) 通过升级率来比较 SMT 与 PDT 的短期和长期效率 (3) 比较 SMT 与 PDT 的短期和长期成本（按付款人衡量） 支出和患者费用分摊。旨在降低偏差和混杂风险的严格方法将 包括加权倾向评分和工具变量方法。这项研究的方法是 创新是因为人们对非药物治疗方法的价值知之甚少 老年人中的 NP。该项目承诺通过评估非-的价值来挑战现状 高风险处方药的药理学替代品。 SMT 对于 NP 护理的卓越价值的证据 将促进从长期使用镇痛剂的危害转向非镇痛剂的创新转变 药物干预。该项目还包括引入大规模卫生保健的实用计划 在学生参与下为两个教育机构提供服务研究，这些机构培训互补和 综合医疗保健临床医生。这项研究的贡献预计将是巨大的，因为有证据表明 支持 SMT 有望提高 NP 老年人护理的安全性、效率和价值。

项目成果

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