medRxiv, 2023/01, published online 2023/01/11. doi: 10.1101/2023.01.10.23284193, type of study: ,cos,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (http://medrxiv.org/content/early/2023/01/11/2023.01.10.23284193.abstract)

Keywords:

neck pain [180]
non-pharmaceutical therapies [2]
costs [18]
economics [58]
chiropractic [126]
manual therapy [169]
osteopathic manipulative treatment [3946]
OMT [3925]
cohort study [90]

Abstract:

Background Neck pain (NP) is prevalent and costly. NP clinical practice guidelines are similar to those for low back pain (LBP), emphasizing non-pharmaceutical and non-interventional first-line approaches. Primary care providers (PCP) are frequently consulted by individuals with NP.Objective Examine the association between guideline concordant incorporation of non-pharmaceutical therapies, use of imaging, pharmaceutical, and interventional services, and total episode cost for individuals with NP initially contacting a PCP.Design Retrospective cohort study using identical methods to a previous LBP studySetting/Patients National sample of individuals with non-surgical NP occurring in 2017-2019.Measurements Independent variables were initial contact with a PCP, and the timing of incorporation of 5 types of non-pharmaceutical therapies. Dependent measures included use of 13 types of health care services and total episode cost.Results 70,252 PCPs were initially contacted by 124,780 individuals with 137,274 episodes of non-surgical NP. 30.9% of PCPs and 22.1% of episodes included at least one of five non-pharmaceutical services at any time during an episode. Active care (13.7% of episodes), manual therapy (10.8%), and chiropractic manipulative therapy (9.4%) were the most common non-pharmaceutical services. 7.4% of episodes included a non-pharmaceutical service during the first 7 days with these episodes associated with a modest reduction (risk ratio 0.28 to 0.78) in the use of prescription pharmaceuticals. Younger individuals from ZIP codes with higher adjusted gross income were more likely to receive a non-pharmaceutical service in the first 7 days of an episode. When included during an episode, non-pharmaceutical services were associated with an increase in total episode cost with the smallest increase associated with chiropractic and osteopathic manipulation. Limitations As a retrospective observational analysis of associations there are numerous potential confounders and limitations.Conclusions Non-pharmaceutical services are infrequently provided to individuals with non-surgical NP initially contacting a PCP. For these individuals, non-pharmaceutical services, if provided, are most commonly introduced later in an episode after receiving pharmaceutical, imaging, and interventional services. For individuals with NP initially contacting a PCP there is an opportunity to increase the guideline concordant incorporation of non-pharmaceutical services early in an episode.