Cost effectiveness of spinal manipulative therapy for seniors with neck pain

描述(由申请者提供)：该项目的长期目标是使申请者做好准备，成为一名独立的临床研究科学家，研究脊柱手法疗法(SMT)治疗颈背痛的临床和成本效益。布伦特·莱宁格，华盛顿特区，作为一名脊椎按摩师执业三年。他正在参加西北健康科学大学(NWHSU)的桥梁奖学金计划，该计划为CAM从业者从事研究事业做好准备。Leininger博士的主要赞助人是西北健康科学大学的Gert Bronfort博士，他是颈部和背部疼痛SMT领域的知名临床研究员。在奖学金期间，Leininger博士将参加实践研究培训、正式课程工作和一个研究项目。Bronfort博士的临床研究中心(Wolfe-Harris临床研究中心)将通过轮换获得实际研究经验，其中将包括纳入/排除标准的临床应用、SMT在临床研究中的应用、统计分析/解释和科学写作。与达特茅斯研究所和明尼苏达大学(U Of M)的健康经济学家(共同赞助McDonough博士、顾问Tosteson博士和Nyman博士)合作，将在进行随机试验的同时提供与进行经济评估有关的实际研究培训和指导。明尼苏达大学临床和成本效益研究的正式课程将最终获得临床研究的理学硕士学位，并将补充实际学习经验。通过拟议的研究项目，莱宁格博士将成为第一批从社会角度评估SMT在患有慢性颈部疼痛的老年人中的经济价值的人之一。研究对象为他的主要赞助人的研究(R18HP01425)。申请人的项目有三个具体的目标，这三个目标是对父母试验的补充，将包括评估SMT与监督锻炼和家庭锻炼对使用疼痛的老年人慢性颈部疼痛的成本效益、质量调整的生命年和一年随访期的残疾结果。通过一个有组织的三年培训计划，Leininger博士将在颈部和背部疼痛的SMT临床研究以及成本效益数据收集和分析技术方面获得新的技能。这将由Bronfort博士和共同赞助者(Evans博士和McDonough博士)提供的个性化指导来促进。NWHSU和明尼苏达大学非常适合申请者的培训，包括一个以CAM为重点的临床研究中心和一个NIH附属的CTSA(1UL1RR033183)。 公共卫生相关性：颈部疼痛是一种常见且代价高昂的疾病，对于已经背负着其他健康问题负担的老年人口来说，尤其令人担忧。CAM干预措施，如脊柱操作，在年轻人群中显示出了希望。这项研究项目将探讨脊柱手法治疗老年人慢性颈部疼痛的成本效益。

DESCRIPTION (provided by applicant): The long-term objective of this project is to prepare the applicant to become an independent clinical research scientist investigating the clinical and cost effectiveness of spinal manipulation therapy (SMT) for neck and back pain conditions. Brent Leininger, DC, practiced as a chiropractor for three years. He is participating in a bridge fellowship program at Northwestern Health Sciences University (NWHSU), which readies CAM practitioners to pursue research careers. Dr. Leininger's primary sponsor is Dr. Gert Bronfort at Northwestern Health Sciences University, an established clinical researcher in SMT for neck and back pain conditions. During the fellowship period Dr. Leininger will participate in practical research training, formal coursework, and a research project. Practical research experience will be gained through rotations at Dr. Bronfort's clinical research center (Wolfe-Harris Center for Clinical Studies), which will include clinical application of inclusion/exclusion criteria, applicaion of SMT in clinical research, statistical analyses/interpretation, and scientific writing. Collaboration with health economists (co-sponsor Dr. McDonough, consultants Drs. Tosteson and Nyman) at the Dartmouth Institute and the University of Minnesota (U of M) will provide practical research training and mentorship related to the conduct of economic evaluations alongside randomized trials. Formal coursework in clinical and cost effectiveness research at the University of Minnesota will culminate in a Master's of Science degree in Clinical Research and will complement the practical learning experiences. Through the proposed research project, Dr. Leininger will be among the first to assess the economic value of SMT in seniors with chronic neck pain from a societal perspective. Study subjects were those enrolled in his primary sponsor's study (R18HP01425). The applicant's project has three Specific Aims which are complementary to the parent trial and will include an estimation of the cost effectiveness of SMT versus supervised exercise and home exercise for chronic neck pain in seniors using pain, quality-adjusted life years, and disability outcomes over a one-year follow-up period. Through a structured three year training plan, Dr. Leininger will acquire new skills in clinical research of SMT for neck and back pain conditions, as well as cost effectiveness data collection and analytic techniques. This will be fostered by individualized mentorship provided by Dr. Bronfort and co-sponsors (Drs. Evans and McDonough). NWHSU and the University of Minnesota are well suited for the applicant's training and include a CAM focused clinical research center and an NIH affiliated CTSA (1UL1RR033183). PUBLIC HEALTH RELEVANCE: Neck pain is a common and costly condition and is particularly concerning for senior populations already burdened with other health complaints. CAM interventions, such as spinal manipulation, have shown promise in younger populations. This research project will address the cost-effectiveness of spinal manipulation for chronic neck pain in seniors.