Biopsychosocial intervention, postural therapy may reduce spine pain
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Published results showed a multidisciplinary biopsychosocial intervention or an individualized postural therapy intervention may reduce pain-related disability in patients with acute or subacute spine pain.
At the clinic-level, researchers randomly assigned 2,971 patients with neck or back pain for 3 months or less to receive usual care (n=992); a risk-stratified, multidisciplinary intervention that combined physical therapy, health coach counseling and consultation from a specialist in pain medicine or rehabilitation (n=829); or to individualized postural therapy, which combined physical therapy with building self-efficacy and self-management (n=1,150). Primary outcomes included change in Oswestry Disability Index (ODI) score at 3 months and spine-related health care spending at 1 year.
Among 2,733 patients who finished the trial, results showed mean ODI scores changed from 31.2 to 15.4 for the multidisciplinary intervention, from 29.3 to 15.4 for individualized postural therapy and from 28.9 to 19.5 for usual care between baseline and 3-month follow-up. Researchers found an absolute difference compared with usual care at 3-month follow-up of –5.8 for the multidisciplinary intervention and –4.3 for individualized postural therapy. Researchers also noted the multidisciplinary intervention, the individualized postural therapy and the usual care groups had a mean 12-month spending of $1,448, $2,528 and $1,587, respectively, with differences in spending of –$139 for the multidisciplinary intervention and $941 for individualized postural therapy compared with usual care.
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The authors and institutions that compiled this excellent research study need to be commended. Back pain is the second most common symptom for seeking health care and the leading cause for disability in the world. Few scientific studies, if any, have borne out any statistically significant treatment options for this large cohort of patients.
In this clinical trial, the statistical analysis and randomization of patients were well done. It is interesting that both biopsychosocial intervention and postural therapy intervention resulted in statistically significant reduction in disability. The article touches on cost analysis of these interventions compared with the benefit. It will be a critical component of future treatment recommendations as we will have to prove that the cost is worth the outcome.
If there would be any ability to follow these patients for more than 2 years, it would add value to show long-term benefits from the therapy and interventional group. If these interventions could prevent the development of chronic pain syndrome in the long run, this would be a major breakthrough for the treatment of back and neck pain.
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