Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2011

Open Access 01-12-2011 | Research article

Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

Authors: Pedro Serrano-Aguilar, Francisco M Kovacs, Jose M Cabrera-Hernández, Juan M Ramos-Goñi, Lidia García-Pérez

Published in: BMC Musculoskeletal Disorders | Issue 1/2011

Login to get access

Abstract

Background

Back, neck and shoulder pain are the most common causes of occupational disability. They reduce health-related quality of life and have a significant economic impact. Many different forms of physical treatment are routinely used. The objective of this study was to estimate the cost of physical treatments which, despite the absence of evidence supporting their effectiveness, were used between 2004 and 2007 for chronic and non-specific neck pain (NP), back pain (BP) and shoulder pain (SP), within the Spanish National Health Service in the Canary Islands (SNHSCI).

Methods

Chronic patients referred from the SNHSCI to private physical therapy centres for NP, BP or SP, between 2004 and 2007, were identified. The cost of providing physical therapies to these patients was estimated. Systematic reviews (SRs) and clinical practice guidelines (CPGs) for NP, BP and SP available in the same period were searched for and rated according to the Oxman and AGREE criteria, respectively. Those rated positively for ≥70% of the criteria, were used to categorise physical therapies as Effective; Ineffective; Inconclusive; and Insufficiently Assessed. The main outcome was the cost of physical therapies included in each of these categories.

Results

8,308 chronic cases of NP, 4,693 of BP and 5,035 of SP, were included in this study. Among prescribed treatments, 39.88% were considered Effective (physical exercise and manual therapy with mobilization); 23.06% Ineffective; 13.38% Inconclusive, and 23.66% Insufficiently Assessed. The total cost of treatments was € 5,107,720. Effective therapies accounted for € 2,069,932.

Conclusions

Sixty percent of the resources allocated by the SNHSCI to fund physical treatment for NP, BP and SP in private practices are spent on forms of treatment proven to be ineffective, or for which there is no evidence of effectiveness.
Appendix
Available only for authorised users
Literature
1.
Andersson GBJ: The epidemiology of spinal disorders. The Adult Spine: Principles and Practice. Edited by: Frymoyer JW. 1997, New York: Raven Press, 93-141. 2
2.
Kvarnstrom S: Occurrence of musculoskeletal disorders in a manufacturing industry with special attention to occupational shoulders. Scand J Rehab Med. 1983, 8 (Suppl): 1-114.
3.
Cailliet R: Shoulder pain. 1991, Philadelphia: F.A. Davis Co, 3
4.
Sáinz de Murieta E, Fernández Baraibar J, Pascual I, Mena A, Martínez-Zubiri A, Condón MJ: Occupational disability due to locomotor pathology in the Foral Community of Navarra. Epidemiological aspects. An Sist Sanit Navar. 2005, 28 (1): 83-92.CrossRefPubMed
5.
Rajala U, Keinänen-Kiukaanniemi S, Uusimäki A, Kivelä SL: Musculoskeletal pain and depression in a middle-aged Finnish population. Pain. 1995, 61 (3): 451-457. 10.1016/0304-3959(94)00206-T.CrossRefPubMed
6.
Côté P, Kristman V, Vidmar M, Van Eerd D, Hogg-Johnson S, Beaton D, Smith PM: The prevalence and incidence of work absenteeism involving neck pain: a cohort of Ontario lost-time claimants. Spine. 2008, 33 (Suppl 4): S192-198.CrossRefPubMed
7.
Maniadakis N, Gray A: The economic burden of back pain in the UK. Pain. 2000, 84 (1): 95-103. 10.1016/S0304-3959(99)00187-6.CrossRefPubMed
8.
van Tulder MW, Koes BW, Bouter LM: A cost-of-illness study of back pain in The Netherlands. Pain. 1995, 62 (2): 233-240. 10.1016/0304-3959(94)00272-G.CrossRefPubMed
9.
Waddell G, Burton K, Aylward M: Work and common health problems. J Insur Med. 2007, 39 (2): 109-120.PubMed
10.
11.
Deyo RA, Rainville J, Kent DL: What can the history and physical examination tell us about back pain?. JAMA. 1992, 268 (6): 760-765. 10.1001/jama.1992.03490060092030.CrossRefPubMed
12.
Bassols A, Bosch F, Campillo M, Baños JE: Back pain in the general population of Catalonia (Spain). Prevalence, characteristics and therapeutic behavior. Gac Sanit. 2003, 17 (2): 97-107. 10.1157/13046566.CrossRefPubMed
13.
Ballina Garcia FJ, Hernandez Mejía R, Martín Lascuevas P, Fernandez Santana J, Cueto Espinar A: Epidemiology of musculoskeletal complaints and use of health services in Asturias, Spain. Scand J Rheumatol. 1994, 23 (3): 137-141. 10.3109/03009749409103046.CrossRefPubMed
14.
Pope DP, Croft PR, Pritchard CM, Silman AJ: Prevalence of shoulder pain in the community: the influence of case definition. Ann Rheum Dis. 1997, 56: 308-312. 10.1136/ard.56.5.308.CrossRefPubMedPubMedCentral
15.
16.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, COST B13 Working Group on Guidelines for Chronic Low Back Pain: Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006, 15 (Suppl 2): S192-S300.CrossRefPubMedPubMedCentral
17.
18.
Merskey H, Bogduk N: Classification of chronic pain. Description of chronic pain syndromes and definitions of pain terms. 1994, IASP Press, 60-74. 2
19.
20.
Oxman AD, Cook DJ, Guyatt GH: User's Guides to the medical literature. VI. How to use an overview. JAMA. 1994, 272 (17): 1367-1371. 10.1001/jama.1994.03520170077040.CrossRefPubMed
21.
Philadelphia Panel: Philadelphia Panel Evidence-Based Clinical Practice Guidelines on selected rehabilitation interventions for neck pain. Phys Ther. 2001, 81 (10): 1701-1717.
22.
Ezzo J, Haraldsson BG, Gross AR, Myers CD, Morien A, Goldsmith CH, Bronfort G, Peloso PM, Cervical Overview Group: Massage for mechanical neck disorders: a systematic review. Spine. 2007, 32 (3): 353-62. 10.1097/01.brs.0000254099.07294.21.CrossRefPubMed
23.
Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G, Cervical Overview Group: Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2005, CD004250-3
24.
Kroeling P, Gross AR, Goldsmith CH, Cervical Overview Group: A Cochrane review of electrotherapy for mechanical neck disorders. Spine. 2005, 30 (21): E641-E648. 10.1097/01.brs.0000184302.34509.48.CrossRefPubMed
25.
Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri SA, Mortaz Hejri SO, Jonaidi A: Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev. 2008, CD005107-2
26.
Khadilkar A, Milne S, Brosseau L, Wells G, Tugwell P, Robinson V, Shea B, Saginur M: Transcutaneous electrical nerve stimulation for the treatment of chronic back pain: a systematic review. Spine. 2005, 30 (23): 2657-2666. 10.1097/01.brs.0000188189.21202.0f.CrossRefPubMed
27.
Clarke JA, van Tulder MW, Blomberg SEI, de Vet HC, van der Heijden GJ, Bronfort G, Bouter LM: Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007, CD003010-2
28.
Hayden JA, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005, CD000335-3
29.
French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ: A Cochrane review of superficial heat or cold for low back pain. Spine. 2006, 31 (9): 998-1006. 10.1097/01.brs.0000214881.10814.64.CrossRefPubMed
30.
Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004, CD000447-1
31.
Green S, Buchbinder R, Hetrick S: Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003, CD004258-2
32.
Verhagen AP, Karels C, Bierma-Zeinstra SM, Feleus A, Dahaghin S, Burdorf A, Koes BW: Exercise proves effective in a systematic review of work-related complaints of the arm, neck or shoulder. J Clin Epidemiol. 2007, 60 (2): 110-117.CrossRefPubMed
33.
Chow RT, Barnsley L: Systematic review of the literature of low-level laser therapy (LLLT) in the management of neck pain. Lasers Surg Med. 2005, 37 (1): 46-52. 10.1002/lsm.20193.CrossRefPubMed
34.
Vernon H, Humphreys K, Hagino C: Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther. 2007, 30 (6): 473-478.CrossRef
35.
Plat E, Scherer M, Van Weel C: The treatment of neck pain. A systematic review. Huisarts Wet. 2007, 50 (13): 660-665.CrossRef
36.
Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G, Cervical overview group: Manipulation and mobilisation for mechanical neck disorders. Cochrane Database Syst Rev. 2004, CD004249-1
37.
Chou R, Huffman LH, American Pain Society. American College of Physicians: Nonpharmacologic therapies for acute and chronic back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007, 147 (7): 492-504.CrossRefPubMed
38.
Pichón RA, Augustovski F, Alcaraz A, Bardach A, Ferrante D, Garcia MS: Transcutaneous electrical nerve stimulation (TENS-PENS) for back pain. 2006, Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS)
39.
Ho C: Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain) [Issues in emerging health technologies issue 96 part 3]. 2007, Ottawa: Canadian Agency for Drugs and Technologies in Health
40.
Harniman E, Carette S, Kennedy C, Beaton D: Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther. 2004, 17 (2): 132-151. 10.1197/j.jht.2004.02.003.CrossRefPubMed
41.
Neck and upper back complaints. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery of workers. Edited by: Glass LS. 2004, Beverly Farms: OEM Press, 164-193. 2
42.
Cervical/thoracic. Clinical Guidelines for the Queensland Workers compensation Scheme. 2008, Back. Queensland: Q-Comp, 88-92.
43.
Gross AR, Kay TM, Kennedy C, Gasner D, Hurley L, Yardley K, Hendry L, McLaughlin L: Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. Man Ther. 2002, 7 (4): 193-205. 10.1054/math.2002.0477.CrossRefPubMed
44.
Philadelphia Panel: Philadelphia Panel Evidence-Based Clinical Practice Guidelines on selected rehabilitation interventions for shoulder pain. Phys Ther. 2001, 81 (10): 1719-1730.
45.
46.
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians. American College of Physicians. American Pain Society Back Pain Guidelines Panel: Diagnosis and treatment of back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007, 147 (7): 478-491.CrossRefPubMed
47.
Koes BW, Sanders RJ, Tuut MK, Kwaliteitsinstituut voor de Gezondheidszorg CBO: The Dutch Institute for Health Care Improvement (CBO) guideline for the diagnosis and treatment of a specific acute and chronic back complaints. Ned Tijdschr Geneeskd. 2004, 148 (7): 310-314.PubMed
48.
American College of Occupational and Environmental Medicine (ACOEM): Shoulder complaints. 2004, Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM)
49.
New Zealand Guidelines Group: The diagnosis and management of soft tissue shoulder injuries and related disorders. Best practices evidence based guideline. 2004, New Zealand Guidelines Group
50.
Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomás M, Mir MA, Cano A, Muriel A, Zamora J, Gil del Real MT, Gestoso M, Mufraggi N: Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008, 9: 43-10.1186/1471-2474-9-43.CrossRefPubMedPubMedCentral
51.
Pool JJM, Ostelo RWJG, Hoving JL, Bouter LM, de Vet HCW: Minimal clinically important change of the neck disability index and the numerical rating scale for patients with neck pain. Spine. 2007, 32 (26): 3047-3051. 10.1097/BRS.0b013e31815cf75b.CrossRefPubMed
52.
Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, Muriel A, Zamora J, Gil del Real MT, Gestoso M, Mufraggi N, Spanish Back Pain Research Network: Minimal clinically important change for pain intensity and disability in patients with nonspecific back pain. Spine. 2007, 32 (25): 2915-2920. 10.1097/BRS.0b013e31815b75ae.CrossRefPubMed
53.
Verbeek J, Sengers MJ, Riemens L, Haafkens J: Patient Expectations of Treatment for Back Pain. A Systematic Review of Qualitative and Quantitative Studies. Spine. 2004, 29 (20): 2309-2318. 10.1097/01.brs.0000142007.38256.7f.CrossRefPubMed
54.
Geraets JJ, Goossens ME, de Bruijn CP, de Groot IJ, Köke AJ, Pelt RA, Van der Heijden G, Dinant GJ, van den Heuvel WJ: Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. Int J Technol Assess Health Care. 2006, 22 (1): 76-83.CrossRefPubMed
55.
Schers H, Wensing M, Huijsmans Z, van Tulder M, Grol R: Implementation barriers for general practice guidelines on back pain a qualitative study. Spine. 2001, 26 (15): E348-E353. 10.1097/00007632-200108010-00013.CrossRefPubMed
56.
57.
58.
Kovacs FM, Llobera J, Abraira V, Lázaro P, Pozo F, Kleinbaum D, the KAP Group: Effectiveness and cost effectiveness analysis of neuroreflexotherapy for subacute and chronic low back pain in routine general practice. A cluster randomized, controlled trial. Spine. 2002, 27 (11): 1149-1159. 10.1097/00007632-200206010-00004.CrossRefPubMed
59.
Urrútia G, Burton AK, Morral A, Bonfill X, Zanoli G: Neuroreflexotherapy for non-specific low-back pain. Cochrane Database Syst Rev. 2004, CD003009-2
60.
Corcoll J, Orfila J, Tobajas P, Alegre L: Implementation of neuroreflexotherapy for subacute and chronic neck and back pain within the Spanish public health system: audit after one year. Health Policy. 2006, 79 (2-3): 345-357. 10.1016/j.healthpol.2005.11.001.CrossRefPubMed
61.
Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, et al.: The treatment of acute low back pain--bed rest, exercises, or ordinary activity?. N Engl J Med. 1995, 332 (6): 351-355. 10.1056/NEJM199502093320602.CrossRefPubMed
62.
Carragee EJ, Deyo RA, Kovacs FM, Peul WC, Lurie JD, Urrútia G, Corbin TP: Clinical Research. Is the Spine Field a Mine Field?. Spine. 2009, 34 (5): 423-430. 10.1097/BRS.0b013e318198c962.CrossRefPubMed
63.
Manca A, Dumville JC, Torgerson DJ, Klaber Moffett JA, Mooney MP, Jackson DA, Eaton S: Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost effectiveness analysis. Rheumatology. 2007, 46 (9): 1495-1501. 10.1093/rheumatology/kem183.CrossRefPubMed
64.
Sespas Report 2006. Maladjustment of Health in developed world. Gac Sanit. Edited by: Palomo L, Ortún V, García-Benavides F, Marzquez-Calderón S. 2006, 20 (Suppl 1): 2-9.
65.
Law 16/2003, of May 28, of Cohesion and Quality for the National Health System: Boletín Oficial del Estado. 2003, 128: 20567-20588.
66.
67.
Kovacs FM, Fernandez C, Cordero A, Muriel A, González-Luján L, the Spanish Back Pain Research Network: Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management. BMC Health Services Research. 2006, 6: 57-10.1186/1472-6963-6-57.CrossRefPubMedPubMedCentral
68.
Lindsay DM, Dearness J, McGinley CC: Electrotherapy usage trends in private physiotherapy practice in Alberta. Physiother Can. 1995, 47 (1): 30-34.PubMed
69.
Di Lorio D, Henley E, Doughty A: A survey of primary care physician practice patterns and adherence to acute low back problem guidelines. Arch Fam Med. 2000, 9 (10): 1015-1021. 10.1001/archfami.9.10.1015.CrossRef
70.
Haldeman S, Dagenais SA: A supermarket approach to the evidence-informed management of chronic low back pain. Spine J. 2008, 8 (1): 1-7. 10.1016/j.spinee.2007.10.009.CrossRefPubMed
71.
Dagenais S, Haldeman S: Evidence-Based management of low back pain. 2012, St. Louis, Missouri: Elservier Mosby, 443-449.
72.
Martin BI, Deyo RA, Mirza SK: Expenditures and Health Status Among Adults With Back and Neck Problems. JAMA. 2008, 299 (6): 656-664. 10.1001/jama.299.6.656.CrossRefPubMed
73.
Lambeek LC, van Tulder MW, Swinkels IC, Koppes LL, Anema JR, van Mechelen W: The trend in total cost of back pain in The Netherlands in the period 2002 to 2007. Spine. 2011, 36 (13): 1050-1058. 10.1097/BRS.0b013e3181e70488.CrossRefPubMed
Metadata
Title
Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study
Authors
Pedro Serrano-Aguilar
Francisco M Kovacs
Jose M Cabrera-Hernández
Juan M Ramos-Goñi
Lidia García-Pérez
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2011
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-12-287

Other articles of this Issue 1/2011

BMC Musculoskeletal Disorders 1/2011 Go to the issue

Research article

Comparison between two pedicle screw augmentation instrumentations in adult degenerative scoliosis with osteoporosis

Case report

Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

Erratum

Erratum to: The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: A randomized controlled trial

Research article

Infraglenoidal scapular notching in reverse total shoulder replacement: a prospective series of 60 cases and systematic review of the literature

Research article

Associations between proinflammatory cytokines in the synovial fluid and radiographic grading and pain-related scores in 47 consecutive patients with osteoarthritis of the knee

Study protocol

A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study