医学
生活质量(医疗保健)
物理疗法
随机对照试验
颈部疼痛
可视模拟标度
置信区间
不利影响
统计显著性
成本效益
外科
内科学
替代医学
风险分析(工程)
病理
护理部
作者
Daniel Pach,Mike Piper,Fabian Lotz,Thomas Reinhold,Mirja Dombrowski,Yinghui Chang,Bin Liu,Susanne Blödt,Gabriele Rotter,Katja Icke,Claudia M. Witt
标识
DOI:10.1089/acm.2017.0209
摘要
Objective: To evaluate whether tuina is more effective and cost-effective in reducing pain compared to no intervention in patients with chronic neck pain. Design: Single-center randomized two-armed controlled trial. Setting: University outpatient clinic specialized in Integrative Medicine. Subjects: Outpatients with chronic neck pain were randomly allocated to tuina or no intervention. Intervention: Six tuina treatments within 3 weeks. Outcome measures: The primary outcome was the mean neck pain intensity during the previous 7 days on a visual analogue scale after 4 weeks (VAS, 0–100 mm, 0 = no pain, 100 = worst imaginable pain). Secondary outcomes included Neck Pain and Disability Scale (NPDS), Neck Disability Index (NDI), health-related quality of life (12-item quality-of-life questionnaire [SF-12]), medication intake, and cost-effectiveness after 4 and 12 weeks. Statistical analysis included analysis of covariance adjusted for baseline values and a full economic analysis from a societal perspective. Results: Altogether, 92 outpatients were included (46 in both groups, 87% female, mean age 45.4 [standard deviation ±9.7], and mean VAS 57.7 ± 11.5). Tuina treatment led to a clinically meaningful reduction in neck pain intensity (group differences, 4 weeks: −22.8 mm [95% confidence interval, −31.7 to −13.8]; p < 0.001 and 12 weeks: −17.9 mm [−27.1 to −8.8], p < 0.001). No serious adverse events were observed. Total costs as well as quality-adjusted life years (QALYs) did not differ significantly between the groups. When taking group differences into account independently from their statistical significance, costs per QALY gained (incremental cost-effectiveness ratio) would range within a cost-effective area from €7,566 (for costs €10.28 per session) to €39,414 (cost €35 per session). Conclusion: An additional treatment with six tuina sessions over 3 weeks was effective, safe and relatively cost-effective for patients with chronic neck pain. A future trial should compare tuina to other best care options.
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