Introduction
Methods
Design
Participants
Interventions
Manual Therapy according to the Utrecht school
Physiotherapy
Clinical measures
Cost measures
Data analysis
Sensitivity analyses
Results
Participants
Baseline characteristics | MTU group | PT group | ||||||
---|---|---|---|---|---|---|---|---|
All (n = 90) | Complete (n = 61) | Incomplete (n = 29) |
P value | All (n = 91) | Complete (n = 52) | Incomplete (n = 39) |
P value | |
Female [n (%)] | 56 (62.2) | 39 (63.9) | 17 (58.6) | 0.627 | 56 (61.5) | 25 (48.7) | 31 (79.5) | 0.002 |
Age (years) [mean (SD)] | 49.2 (12.4) | 47.3 (12.8) | 53.3 (10.8) | 0.030 | 48.7 (12.6) | 49.5 (13.0) | 47.8 (12.2) | 0.529 |
First neck pain episode [n (%)] | 56 (62.2) | 38 (62.3) | 18 (62.1) | 0.767 | 58 (63.7) | 33 (63.5) | 25 (64.1) | 0.950 |
Main complaint [n (%)] | ||||||||
Pain | 79 (87.8) | 55 (90.2) | 24 (82.8) | 0.316 | 80 (87.9) | 44 (84.6) | 36 (92.3) | 0.265 |
Stiffness | 30 (33.3) | 20 (32.8) | 10 (25.6) | 0.873 | 38 (41.8) | 20 (38.5) | 18 (46.2) | 0.007 |
Mobility impairment | 33 (36.7) | 17 (27.9) | 16 (55.2) | 0.005 | 37 (40.7) | 18 (34.6) | 19 (48.7) | 0.175 |
Other | 7 (7.8) | 1 (1.6) | 6 (20.7) | 0.002 | 10 (11.0) | 8 (15.4) | 2 (5.1) | 0.122 |
Complaint intensity (NRS: 0–10) [mean (SD)] | 5.5 (2.0) | 5.4 (2.1) | 5.7 (2.0) | 0.531 | 5.8 (1.8) | 5.7 (1.6) | 6.1 (2.1) | 0.296 |
Functional status (NDI-DV: 0–50) [mean (SD)] | 12.5 (6.8) | 11.6 (5.6) | 14.5 (8.7) | 0.061 | 11.7 (5.4) | 11.0 (4.5) | 12.6 (6.3) | 0.157 |
Utility score (0–1) [mean (SD)] | 0.71 (0.13) | 0.73 (0.11) | 0.65 (0.14) | 0.009 | 0.71 (0.12) | 0.72 (0.11) | 0.69 (0.12) | 0.148 |
Effects
Resource use and costs
Cost category | MTU group
n = 90; mean (SEM) | PT group
n = 91; mean (SEM) | Mean cost difference (95 % CI) |
---|---|---|---|
Intervention | 114 (6) | 145 (9) | −32 (−54 to −10) |
Healthcarea
| 172 (28) | 298 (43) | −126 (−235 to −32) |
Primary healthcare | 117 (18) | 226 (34) | −109 (−207 to 45) |
Secondary healthcare | 48 (17) | 58 (17) | −10 (−55 to 41) |
Medication | 7 (3) | 14 (5) | −7 (−23 to 1) |
Informal care | 106 (64) | 62 (22) | 43 (−36 to 310) |
Absenteeism | 1702 (726) | 1870 (656) | −168 (−1994 to 1810) |
Unpaid productivity | 348 (115) | 162 (36) | 186 (19 to 557) |
Total | 2442 (758) | 2537 (681) | −96 (−1975 to 2022) |
Cost-effectiveness
Analysis | Sample size | Outcome | ∆C (95 % CI) | ∆E (95 % CI) | ICER | Distribution CE-plane (%) | ||||
---|---|---|---|---|---|---|---|---|---|---|
MTU | PT | € | Points | €/point | NEa
| SEb
| SWc
| NWd
| ||
Main analysis—imputed dataset | 90 | 91 | Perceived recovery (range: 0–1) | −96 (−1975 to 2022) | 0.09 (−0.05 to 0.24) | −1024 | 39.2 | 50.3 | 4.7 | 5.7 |
90 | 91 | Functional status— continuous (range: 0–50) | −96 (−1975 to 2022) | −1.03 (−2.55 to 0.48) | 92 | 40.8 | 50.3 | 4.7 | 4.2 | |
90 | 91 | Functional status—≥4 point improvement (range: 0–1) | −96 (−1975 to 2022) | −0.01 (−0.15 to 0.13) | 7314 | 20.1 | 23.7 | 31.3 | 24.9 | |
90 | 91 | QALYs (range: 0–1) | −96 (−1975 to 2022) | −0.01 (−0.04 to 0.03) | 14,561 | 13.6 | 23.5 | 31.7 | 31.2 | |
SA1—complete-cases | 61 | 52 | Perceived recovery (range: 0–1) | −272 (−747 to 203) | 0.15 (−0.03 to 0.33) | −1779 | 12.7 | 82.6 | 3.5 | 1.3 |
61 | 52 | Functional status—continuous (range: 0–50) | −272 (−747 to 203) | −0.48 (−2.24 to 1.27) | 561 | 6.9 | 63.2 | 23.7 | 6.1 | |
61 | 52 | Functional status—≥4 point improvement (range: 0–1) | −272 (−747 to 203) | −0.84 (2.94 to 1.17) | 322 | 3.0 | 17.4 | 68.4 | 11.1 | |
61 | 52 | QALYs (range: 0–1) | −272 (−747 to 203) | −0.02 (−0.07 to 0.03) | 14,726 | 1.8 | 21.2 | 57.9 | 19.2 | |
SA2—HCA | 90 | 91 | Perceived recovery (range: 0–1) | 84 (−1883 to 2590) | 0.09 (−0.05 to 0.24) | 903 | 45.0 | 44.5 | 4.1 | 6.4 |
90 | 91 | Functional status—continuous (range: 0–50) | 84 (−1883 to 2590) | −1.03 (−2.55 to 0.48) | −82 | 46.5 | 44.6 | 4.1 | 4.8 | |
90 | 91 | Functional status—≥4 point (range: 0–1) | 84 (−1883 to 2590) | −0.01 (−0.15 to 0.13) | −6448 | 22.7 | 21.1 | 27.5 | 28.7 | |
90 | 91 | QALYs (range: 0–1) | 84 (−1883 to 2590) | −0.01 (−0.04 to 0.03) | −12,836 | 15.5 | 20.9 | 27.7 | 35.9 | |
SA3—EQ-5D | 90 | 91 | QALYs (range: 0–1) | −96 (−1975 to 2022) | −0.01 (−0.05 to 0.03) | 10,877 | 10.1 | 22.5 | 32.6 | 34.9 |