Tsertsvadze, Alexander, Clar, Christine, Court, Rachel A., Clarke, Aileen, Mistry, Hema and Sutcliffe, P. (Paul) (2014) Cost-effectiveness of manual therapy for the management of musculoskeletal conditions : A systematic review and narrative synthesis of evidence from randomized controlled trials. Journal of Manipulative and Physiological Therapeutics, Volume 37 (Number 6). pp. 343-362. doi:10.1016/j.jmpt.2014.05.001 ISSN 0161-4754.

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Abstract

Objectives:
The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

Methods:
A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

Results:
Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

Conclusions:
Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Musculoskeletal system -- Diseases -- Chiropractic treatment
Journal or Publication Title:	Journal of Manipulative and Physiological Therapeutics
Publisher:	Mosby Inc
ISSN:	0161-4754
Official Date:	July 2014
Dates:	Date Event July 2014 Published 27 June 2014 Available 1 May 2014 Accepted 16 January 2014 Submitted
Volume:	Volume 37
Number:	Number 6
Number of Pages:	20
Page Range:	pp. 343-362
DOI:	10.1016/j.jmpt.2014.05.001
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Royal College of Chiropractors

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