AUGUST 17, 2023
Use of a multidisciplinary biopsychosocial intervention and individualized postural therapy (IPT) reduced spine pain disability more than usual care, according to new research.
The study (JAMA 2022;328[23]:2334-2344) compared cost and effectiveness of two noninvasive spine-pain therapies: Identify, Coordinate and Enhance (ICE), a risk-stratified multidisciplinary care model that uses physical therapy (PT) and pain medicine and rehabilitation counseling, and IPT, a combination of PT and
Use of a multidisciplinary biopsychosocial intervention and individualized postural therapy (IPT) reduced spine pain disability more than usual care, according to new research.
The study (JAMA 2022;328[23]:2334-2344) compared cost and effectiveness of two noninvasive spine-pain therapies: Identify, Coordinate and Enhance (ICE), a risk-stratified multidisciplinary care model that uses physical therapy (PT) and pain medicine and rehabilitation counseling, and IPT, a combination of PT and self-efficacy and management. Randomized in a cluster clinical trial and conducted between 2017 and 2020 at 33 centers in the United States, the trial included 2,971 participants with neck or back pain lasting no more than three months
Primary outcomes showed that ICE reduced back disability scores from 31.2 to 15.4, IPT from 29.3 to 15.4, and usual care from 28.9 to 19.5 when measured on the Oswestry Disability Index at three months. Healthcare spending for ICE dropped by $139 per participant but increased for IPT by $941 when compared with usual care at 12-months, according to the authors. There was “no significant difference in spine-related healthcare spending for biopsychosocial interventions,” they noted.
“Our findings show two intervention arms achieved greater rates of clinical improvement at three months than usual care and those improvements were, on average, sustained for the remainder of the 12-month observation period,” said author Sheila Fifer, PhD, a senior advisor to Stanford University’s Clinical Excellence Research Center, in Palo Alto, Calif.
Fifer called spine pain “one of the highest-cost, most common conditions, because so much of the treatments given are not effective. The issue of how to control costs by reducing ineffective and dangerous treatments is important.”
According to Evan Johnson, DPT, MS, OCS, the director of Och Spine Care Outpatient Clinical Research Physical Therapy Services, in New York City: “It appears the cost relationship between usual care, IPT and ICE [is] quite consistent across time. As treatment is provided, costs will rise proportionally. In this study, the time spent in the IPT group was more extensive and resulted in greater overall costs throughout the study period.”
The takeaway message from the research, Fifer said, is that “patients, given low-intensity, lower-cost care, such as ICE or PT, recover from acute spine care quickly. A separate follow-up study could address how best to implement ICE and PT care in real-world settings.”
Johnson advised more research “to clarify the extent of the benefit and how this affects long-term spine health.
Further clarity allows patients, healthcare providers and payors to select the most effective and cost-effective treatment for a condition that disables many. Ongoing analysis to further understand the interaction between injury, behavior and LBP is essential to facilitate effective treatment for millions suffering with LBP.
“LBP is a multifactorial condition that often defies simple answers or one-track treatment. From a societal perspective, it is also important to know the costs of various treatments when determining its feasibility,” said Johnson, a member of the North American Spine Society.
—Sheree Geyer
