RESUMEN
Importance: Low back and neck pain are often self-limited, but health care spending remains high. Objective: To evaluate the effects of 2 interventions that emphasize noninvasive care for spine pain. Design, Setting, and Participants: Pragmatic, cluster, randomized clinical trial conducted at 33 centers in the US that enrolled 2971 participants with neck or back pain of 3 months' duration or less (enrollment, June 2017 to March 2020; final follow-up, March 2021). Interventions: Participants were randomized at the clinic-level to (1) usual care (n = 992); (2) a risk-stratified, multidisciplinary intervention (the identify, coordinate, and enhance [ICE] care model that combines physical therapy, health coach counseling, and consultation from a specialist in pain medicine or rehabilitation) (n = 829); or (3) individualized postural therapy (IPT), a postural therapy approach that combines physical therapy with building self-efficacy and self-management (n = 1150). Main Outcomes and Measures: The primary outcomes were change in Oswestry Disability Index (ODI) score at 3 months (range, 0 [best] to 100 [worst]; minimal clinically important difference, 6) and spine-related health care spending at 1 year. A 2-sided significance threshold of .025 was used to define statistical significance. Results: Among 2971 participants randomized (mean age, 51.7 years; 1792 women [60.3%]), 2733 (92%) finished the trial. Between baseline and 3-month follow-up, mean ODI scores changed from 31.2 to 15.4 for ICE, from 29.3 to 15.4 for IPT, and from 28.9 to 19.5 for usual care. At 3-month follow-up, absolute differences compared with usual care were -5.8 (95% CI, -7.7 to -3.9; P < .001) for ICE and -4.3 (95% CI, -5.9 to -2.6; P < .001) for IPT. Mean 12-month spending was $1448, $2528, and $1587 in the ICE, IPT, and usual care groups, respectively. Differences in spending compared with usual care were -$139 (risk ratio, 0.93 [95% CI, 0.87 to 0.997]; P = .04) for ICE and $941 (risk ratio, 1.40 [95% CI, 1.35 to 1.45]; P < .001) for IPT. Conclusions and Relevance: Among patients with acute or subacute spine pain, a multidisciplinary biopsychosocial intervention or an individualized postural therapy intervention, each compared with usual care, resulted in small but statistically significant reductions in pain-related disability at 3 months. However, compared with usual care, the biopsychosocial intervention resulted in no significant difference in spine-related health care spending and the postural therapy intervention resulted in significantly greater spine-related health care spending at 1 year. Trial Registration: ClinicalTrials.gov Identifier: NCT03083886.
Asunto(s)
Dolor Musculoesquelético , Enfermedades de la Columna Vertebral , Femenino , Humanos , Persona de Mediana Edad , Terapia Combinada , Gastos en Salud , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/psicología , Dolor Musculoesquelético/terapia , Automanejo , Columna Vertebral , Enfermedades de la Columna Vertebral/economía , Enfermedades de la Columna Vertebral/psicología , Enfermedades de la Columna Vertebral/terapia , Masculino , Modalidades de Fisioterapia , Consejo , Manejo del Dolor/economía , Manejo del Dolor/métodos , Derivación y ConsultaRESUMEN
Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-representative sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PERSPECTIVE: This study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.
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Dolor Crónico , Empleo , Dolor Musculoesquelético , Sistema de Registros/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Seguridad Social/estadística & datos numéricos , Adolescente , Adulto , Dolor Crónico/economía , Dolor Crónico/epidemiología , Dolor Crónico/rehabilitación , Empleo/economía , Empleo/estadística & datos numéricos , Femenino , Humanos , Estudios Longitudinales , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/epidemiología , Dolor Musculoesquelético/rehabilitación , Suecia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not optimally organized. The Network Pain Rehabilitation Limburg 2.0 (NPRL2.0) provides integrated care with a biopsychosocial approach and strives to improve the Quadruple Aim outcomes: pain-related disability of patients with CMP; experiences of care of patients with CMP; meaning in the work of healthcare professionals; and healthcare costs. Firstly, in this study, the effectiveness (with regard to the functioning and participation of patients) of primary care for patients with CMP will be assessed, comparing care organized following the NPRL2.0 procedure with usual care. Secondly, the cost-effectiveness and cost-utility with regard to health-related quality of life and healthcare costs will be assessed. And thirdly, the effect of duration of participation in a local network in primary care will be studied. METHODS: In this pragmatic study, it is expected that two local networks with 105 patients will participate in the prospective cohort study and six local networks with 184 patients in the stepped-wedge based design. Healthcare professionals in the local networks will recruit patients. INCLUSION CRITERIA: age ≥ 18 years; having CMP; willing to improve functioning despite pain; and adequate Dutch literacy. EXCLUSION CRITERIA: pregnancy; and having a treatable medical or psychiatric disease. Patients will complete questionnaires at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4). Questionnaires at T1 and T4 will include the Pain Disability Index and Short Form Health Survey. Questionnaires at T1, T2, T3, and T4 will include the EQ-5D-5L, and iMTA Medical Consumption and Productivity Cost Questionnaires. Outcomes will be compared using linear mixed-model analysis and costs will be compared using bootstrapping methods. DISCUSSION: NPRL2.0 is a multidimensional, complex intervention, executed in daily practice, and therefore needing a pragmatic study design. The current study will assess NPRL2.0 with respect to the Quadruple Aim outcomes: patient health and costs. This will provide more information on the (cost-) effectiveness of the organization of care in a network structure regarding patients with CMP. The other two Quadruple Aim outcomes will be examined alongside this study. Trial registration Netherlands Trial Register: NL7643. https://www.trialregister.nl/trial/7643 .
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Dolor Crónico/rehabilitación , Dolor Musculoesquelético/rehabilitación , Calidad de Vida , Adulto , Dolor Crónico/economía , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Evaluación de la Discapacidad , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Estudios Multicéntricos como Asunto , Dolor Musculoesquelético/economía , Países Bajos , Ensayos Clínicos Pragmáticos como Asunto , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Chronic musculoskeletal pain is one of the main causes of years lived with disability and generates the highest cost of health care among chronic pain conditions. Internet-based treatments have been shown to be an alternative for the treatment of musculoskeletal conditions, in addition to reducing barriers such as travel, high demands on the public health system, lack of time, lack of insurance coverage for private care, and high costs for long-term treatment. The aim of this clinical trial is to develop and test the effectiveness and cost-effectiveness of, an internet-based self-management program based on pain education and exercise for people with chronic musculoskeletal pain. METHODS: This is a prospectively registered, assessor-blinded, two-arm randomised controlled trial with economic evaluation comparing the Internet-based pain education and exercise intervention with a control group that will receive an online booklet. One hundred and sixty patients will be recruited from Sao Paulo, Brazil. Follow-ups will be conducted in post-treatment, 6 and 12 months after randomisation. The conduct of the study, as well as the evaluations and follow-ups will be carried out entirely remotely, through online platforms and telephone calls. The primary outcome will be pain intensity at post-treatment (8 weeks) measured using the 11-item Pain Numerical Rating Scale. Secondary outcomes will be biopsychosocial factors presents in the chronic musculoskeletal pain condition. Costs due to chronic musculoskeletal pain will be also measured, and cost-effectiveness analysis from a societal perspective will performed. DISCUSSION: Our hypothesis is that internet-based pain education and exercise will be better than an online booklet in reducing pain and improving biopsychosocial outcomes in patients with chronic musculoskeletal pain. In addition, we believe that there will be good acceptance of patients for the internet-based intervention and that internet-based intervention will be more cost effective than the online booklet. TRIAL REGISTRATION: The study was prospectively registered at ClinicalTrials.gov ( NCT04274439 , registered 18 February 2020).
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Dolor Crónico/terapia , Internet , Dolor Musculoesquelético/terapia , Folletos , Brasil , Dolor Crónico/economía , Análisis Costo-Beneficio , Terapia por Ejercicio/métodos , Estudios de Seguimiento , Humanos , Dolor Musculoesquelético/economía , Dimensión del Dolor , Estudios Prospectivos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Automanejo/métodos , Resultado del TratamientoRESUMEN
This study determined the predictive capabilities of pain intensity and disability on health care utilization (number of condition-specific health care visits, incident, and chronic opioid use) and costs (total condition-specific and overall medical costs) in the year following an initial evaluation for musculoskeletal pain. We explored pain catastrophizing and spatial distribution of symptoms (ie, body diagram symptom score) as mediators of these relationships. Two hundred eighty-three military service members receiving initial care for a musculoskeletal injury completed a region-specific disability measure, numeric pain rating scale, Pain Catastrophizing Scale, and body pain diagram. Pain intensity predicted all outcomes, while disability predicted incident opioid use only. No mediation effects were observed for either opioid use outcome, while pain catastrophizing partially mediated the relationship between pain intensity and number of health care visits. Pain catastrophizing and spatial distribution of symptoms fully mediated the relationship between pain intensity and both cost outcomes. The mediation effects of pain catastrophizing and spatial distribution of symptoms are outcome specific, and more consistently observed for cost outcomes. Higher pain intensity may drive more condition-specific health care utilization and use of opioids, while higher catastrophizing and larger spatial distribution of symptoms may drive higher costs for services received. PERSPECTIVE: This article examines underlying characteristics that help explain relationships between pain intensity and disability, and the outcomes of health care utilization and costs. Health care systems can use these findings to refine value-based prediction models by considering factors that differentially influence outcomes for health care use and cost of services.
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Analgésicos Opioides , Catastrofización , Personas con Discapacidad , Utilización de Instalaciones y Servicios , Costos de la Atención en Salud , Dolor Musculoesquelético , Evaluación de Resultado en la Atención de Salud , Índice de Severidad de la Enfermedad , Adulto , Analgésicos Opioides/economía , Analgésicos Opioides/uso terapéutico , Catastrofización/tratamiento farmacológico , Catastrofización/economía , Catastrofización/fisiopatología , Personas con Discapacidad/estadística & datos numéricos , Utilización de Instalaciones y Servicios/economía , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitales Militares/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Dolor Musculoesquelético/tratamiento farmacológico , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/fisiopatología , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Musculoskeletal pain conditions incur high costs and produce significant personal and public health consequences, including disability and opioid-related mortality. Persistence of high-cost health care utilization for musculoskeletal pain may help identify system inefficiencies that could limit value of care. The objective of this study was to identify factors associated with persistent high-cost utilization among individuals seeking health care for musculoskeletal pain. METHODS: This was a retrospective cohort study of Medical Expenditure Panel Survey data (2008-2013) that included a non-institutionalized, population-based sample of individuals seeking health care for a musculoskeletal pain condition (n = 12,985). Expenditures associated with musculoskeletal pain conditions over two consecutive years were analyzed from prescribed medicine, office-based medical provider visits, outpatient department visits, emergency room visits, inpatient hospital stays, and home health visits. Persistent high-cost utilization was defined as being in the top 15th percentile for annual musculoskeletal pain-related expenditures over 2 consecutive years. We used multinomial regression to determine which modifiable and non-modifiable sociodemographic, health, and pain-related variables were associated with persistent high-cost utilization. RESULTS: Approximately 35% of direct costs for musculoskeletal pain were concentrated among the 4% defined as persistent high-cost utilizers. Non-modifiable variables associated with expenditure group classification included age, race, poverty level, geographic region, insurance status, diagnosis type and total number of musculoskeletal pain diagnoses. Modifiable variables associated with increased risk of high expenditure classification were higher number of missed work days, greater pain interference, and higher use of prescription medication for pain, while higher self-reported physical and mental health were associated with lower risk of high expenditure classification. CONCLUSIONS: Health care delivery models that prospectively identify these potentially modifiable factors may improve the costs and value of care for individuals with musculoskeletal pain prone to risk for high-cost care episodes.
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Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Dolor Musculoesquelético/economía , Visita a Consultorio Médico/economía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Dolor Musculoesquelético/epidemiología , Aceptación de la Atención de Salud , Análisis de Regresión , Estudios Retrospectivos , Autoinforme , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study was to investigate the associations between number of pain locations, common mental disorders (CMDs), and disability pension (DP). METHODS: Survey data in 1998 to 2003 for 27,165 Swedish twins born in 1935 to 1958 were linked to national DP data until 2013. Pain locations were evaluated for back, low back, sciatica, shoulder, or neck pain, and CMDs for lifetime major depression and 1-month anxiety. RESULTS: The number of pain locations was associated with DP in a dose-response manner. One pain location had a hazard ratio of 1.50 (95% confidence interval 1.35 to 1.68) and five pain locations hazard ratio 4.67 (95% confidence interval 4.11 to 5.30) for DP. Also, CMDs were associated with DP. CONCLUSION: The number of pain locations has a dose-response association with the risk of DP. CMDs predict DP. In strategies to prevent DP, early signs of pain or CMDs should be taken into consideration.
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Ansiedad/economía , Dolor Crónico/economía , Depresión/economía , Dolor Musculoesquelético/economía , Enfermedades Profesionales/economía , Ausencia por Enfermedad/estadística & datos numéricos , Adolescente , Adulto , Dolor Crónico/psicología , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/psicología , Enfermedades Profesionales/psicología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Índice de Severidad de la Enfermedad , Ausencia por Enfermedad/economía , Suecia , Adulto JovenRESUMEN
OBJECTIVES: To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain. PERSPECTIVE: VA healthcare system. METHODS: We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans' medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes. RESULTS: We identified 30,634 younger Veterans with chronic MSD pain as using CIH and 195,424 with no CIH use. CIH users differed from nonusers across all baseline covariates except the Charlson comorbidity index. They also differed on annual pre-CIH-start healthcare costs ($10,729 versus $5,818), pain (4.33 versus 3.76), and opioid use (66.6% versus 54.0%). The HLM results indicated lower annual healthcare costs (-$637; 95% CI: -$1,023, -$247), lower pain (-0.34; -0.40, -0.27), and slightly higher (less than a percentage point) opioid use (0.8; 0.6, 0.9) for CIH users in the year after CIH start. Sensitivity analyses indicated similar results for three most-used CIH approaches (acupuncture, chiropractic care, and massage), but higher costs for those with eight or more CIH visits. CONCLUSIONS: On average CIH use appears associated with lower healthcare costs and pain and slightly higher opioid use in this population of younger Veterans with chronic musculoskeletal pain. Given the VA's growing interest in the use of CIH, further, more detailed analyses of its impacts are warranted.
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Dolor Crónico/economía , Dolor Crónico/terapia , Terapias Complementarias , Medicina Integrativa , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/terapia , Veteranos , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the healthcare use and costs of amplified musculoskeletal pain syndrome (AMPS) in children before diagnosis. STUDY DESIGN: We performed a retrospective study in children with AMPS at a pediatric rheumatology clinic between 2010 and 2014. Data were abstracted on 80 patients after primary rheumatic diseases were excluded. Healthcare visits, medications and diagnostic testing that occurred in the years before diagnosis were collected. The Medical Expenditure Panel Survey was used to estimate visit costs. RESULTS: Patients were adolescent females (89%) and white (86%). The median time to diagnosis was 10.2 months. The median pain score was 6.5 and the median Childhood Health Assessment Questionnaire score was 1.1. In this cohort, 29% had at least 1 ED visit and 5% were hospitalized. All patients saw a rheumatologist and 41% had visited another specialist, typically orthopedics and sports medicine. More than one-half had at least 1 radiographic study and 21% had at least 1 magnetic resonance imaging. The total cost for office, emergency department, and hospital visits for AMPS in all 80 patients was $152 853. The mean cost per patient over the entire study period (2008-2014) was $1911 ± $3808, and 43% of costs were outpatient visits. CONCLUSIONS: Children with AMPS have high levels of disability and take a long time to be diagnosed. As a result, even before diagnosis, they have high levels of healthcare use, diagnostic testing, and medical costs. Early recognition of disability and quicker referral to trained subspecialists may improve the prognosis, reduce unnecessary testing, and reduce the overall costs of healthcare.
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Dolor Crónico/terapia , Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Dolor Musculoesquelético/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Femenino , Humanos , Masculino , Dolor Musculoesquelético/economía , Dimensión del Dolor , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work <6 months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n = 158) had fewer days work absence compared with the control arm (n = 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99), P = 0·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.
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Empleo , Costos de la Atención en Salud , Dolor Musculoesquelético/economía , Atención Primaria de Salud/economía , Orientación Vocacional , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Background: Evidence for the cost-effectiveness of self-management interventions for chronic musculoskeletal pain (CMP) lacks consensus, which may be due to variability in the costing methods employed. Purpose: The purposes of the study were to identify how costs and effects have been assessed in economic analysis of self-management interventions for CMP and to identify the effect of the chosen analytical perspective on cost-effectiveness conclusions. Data Sources: Five databases were searched for all study designs using relevant terms. Study Selection: Two independent researchers reviewed all titles for predefined inclusion criteria: adults (≥18 years of age) with CMP, interventions with a primary aim of promoting self-management, and conducted a cost analysis. Data Extraction: Descriptive data including population, self-management intervention, analytical perspective, and costs and effects measured were collected by one reviewer and checked for accuracy by a second reviewer. Data Synthesis: Fifty-seven studies were identified: 65% (n = 37) chose the societal perspective, of which 89% (n = 33) captured health care utilization, 92% (n = 34) reported labor productivity, 65% (n = 24) included intervention delivery, and 59% (n = 22) captured patient/family costs. Types of costs varied in all studies. Eight studies conducted analyses from both health service and societal perspectives; cost-effectiveness estimates varied with perspective chosen, but in no case was the difference sufficient to change overall policy recommendations. Limitations: Chronic musculoskeletal pain conditions where self-management is recommended, but not as a primary treatment, were excluded. Gray literature was excluded. Conclusion: Substantial heterogeneity in the cost components captured in the assessment of self-management for CMP was found; this was independent of the analytic perspective used. Greater efforts to ensure complete and consistent costings are required if reliable cost-effectiveness evidence of self-management interventions is to be generated and to inform the most appropriate perspective for economic analyses in this field.
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Dolor Crónico/terapia , Análisis Costo-Beneficio , Dolor Musculoesquelético/terapia , Autocuidado/economía , Adulto , Dolor Crónico/economía , Bases de Datos Factuales/estadística & datos numéricos , Humanos , Dolor Musculoesquelético/economía , Evaluación de Resultado en la Atención de Salud , Educación del Paciente como AsuntoRESUMEN
INTRODUCTION: Osteoarthritis (OA) is a highly prevalent painful condition of the musculoskeletal system. The effectiveness of current analgesic options has proven to be limited and improved analgesic treatment is needed. Several randomised placebo-controlled trials have now demonstrated the efficacy of duloxetine, an antidepressant with a centrally acting effect, in the treatment of OA pain. The aim of the current study is to investigate if duloxetine is effective and cost-effective as a third-choice analgesic added to usual care for treating chronic pain compared with usual care alone in general practice. METHODS AND ANALYSIS: A pragmatic open, cluster randomised trial is conducted. Patients with pain due to hip or knee OA on most days of the past 3 months with insufficient benefit of non-steroidal anti-inflammatory drugs or contraindications or intolerable side effects are included. General practices are randomised to either (1) duloxetine and usual care or (2) usual care only. Primary outcome is pain at 3 months measured on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcomes at 3 months and 1 year are pain (WOMAC, at 1 year), function (WOMAC), adverse reactions, quality of life and modification of the response to treatment by the presence of centrally sensitised pain (modified PainDETECT). At 1 year, medical and productivity costs will be assessed. Analyses will be performed following the intention-to-treat principle taking the cluster design into account. ETHICS AND DISSEMINATION: The study is approved by the local Medical Ethics Committee (2015-293). Results will be published in a scientific peer-reviewed journal and will be communicated at conferences. TRIAL REGISTRATION NUMBER: Dutch Trial Registry(ntr4798); Pre-results.
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Dolor Crónico/tratamiento farmacológico , Análisis Costo-Beneficio , Clorhidrato de Duloxetina/uso terapéutico , Articulaciones/patología , Dolor Musculoesquelético/tratamiento farmacológico , Osteoartritis de la Cadera/tratamiento farmacológico , Osteoartritis de la Rodilla/tratamiento farmacológico , Adolescente , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Antidepresivos/economía , Antidepresivos/uso terapéutico , Dolor Crónico/economía , Dolor Crónico/etiología , Clorhidrato de Duloxetina/economía , Femenino , Cadera/patología , Articulación de la Cadera/patología , Humanos , Rodilla/patología , Articulación de la Rodilla/patología , Masculino , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/etiología , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/economía , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/economía , Manejo del Dolor , Calidad de Vida , Proyectos de Investigación , Resultado del TratamientoRESUMEN
OBJECTIVE: Office workers have a high prevalence of musculoskeletal conditions. This can be a significant economic burden due to health-related productivity loss. Individual and work-related factors related to office worker health-related productivity were investigated. METHODS: A survey including the Health and Work Performance Questionnaire, which estimated productivity loss, also recorded individual and work-related factors with potential associations with health-related productivity. Muscle function and workstation ergonomics were examined through physical assessments. Linear models investigated the relationships between these factors and health-related productivity. RESULTS: Significant factors identified were occupational category (0.001â<âPâ<â0.050), job satisfaction (Pâ<â0.001), psychological wellbeing (Pâ=â0.031), and musculoskeletal pain (Pâ=â0.023). Health-related productivity loss was greater in office workers working as managers, with lower job satisfaction and psychological wellbeing, and those with musculoskeletal pain. CONCLUSION: Office worker health-related productivity loss is represented by a combination of both individual and work-related factors.
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Personal Administrativo/psicología , Personal Administrativo/estadística & datos numéricos , Eficiencia , Satisfacción en el Trabajo , Salud Mental , Dolor Musculoesquelético , Absentismo , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/economía , Presentismo/economía , Ensayos Clínicos Controlados Aleatorios como Asunto , AutoinformeRESUMEN
BACKGROUND: The identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care. One subgroup of LBP patients are those with back related leg pain. Leg pain frequently accompanies LBP and is associated with increased levels of disability and higher health costs than simple low back pain. Distinguishing between different types of low back-related leg pain (LBLP) is important for clinical management and research applications, but there is currently no clear agreement on how to define and identify LBLP due to nerve root involvement. The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how leg pain due to nerve root involvement is described and diagnosed in the various systems. METHODS: The search strategy involved nine electronic databases including Medline and Embase, reference lists of eligible studies and relevant reviews. Selected papers were appraised independently by two reviewers using a standardised scoring tool. RESULTS: Of 13,358 initial potential eligible citations, 50 relevant papers were identified that reported on 22 classification systems. Papers were grouped according to purpose and criteria of the classification systems. Five themes emerged: (i) clinical features (ii) pathoanatomy (iii) treatment-based approach (iv) screening tools and prediction rules and (v) pain mechanisms. Three of the twenty two systems focused specifically on LBLP populations. Systems that scored highest following quality appraisal were ones where authors generally included statistical methods to develop their classifications, and supporting work had been published on the systems' validity, reliability and generalisability. There was lack of consistency in how LBLP due to nerve root involvement was described and diagnosed within the systems. CONCLUSION: Numerous classification systems exist that include patients with leg pain, a minority of them focus specifically on distinguishing between different presentations of leg pain. Further work is needed to identify clinically meaningful subgroups of LBLP patients, ideally based on large primary care cohort populations and using recommended methods for classification system development.
Asunto(s)
Costos de la Atención en Salud , Pierna/inervación , Dolor de la Región Lumbar/complicaciones , Dolor Musculoesquelético/clasificación , Raíces Nerviosas Espinales , Personas con Discapacidad , Humanos , Dolor de la Región Lumbar/economía , Dolor de la Región Lumbar/terapia , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/etiología , Dolor Musculoesquelético/terapia , Dimensión del Dolor , Atención Primaria de SaludRESUMEN
BACKGROUND: U.S. occupational lead standards have not changed for decades, while knowledge about lead's health effects has grown substantially. OBJECTIVE: The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages. METHODS: I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures. RESULTS: I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures. CONCLUSIONS: Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.
Asunto(s)
Intoxicación por Plomo/economía , Enfermedades Profesionales/economía , Anemia/economía , Enfermedades Cardiovasculares/economía , Depresión/economía , Oftalmopatías/economía , Femenino , Costos de la Atención en Salud , Gastos en Salud , Humanos , Enfermedades Renales/economía , Neoplasias Pulmonares/economía , Masculino , Dolor Musculoesquelético/economía , Enfermedades del Sistema Nervioso/economía , Salud Reproductiva/economía , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: Examine the prevalence of musculoskeletal pain (MSP) in the six Spanish-speaking countries of Central America using a single standardized instrument, the First Survey on Working Conditions and Health in Central America in workers from all manual and non-manual labor sectors, using social security coverage as an indicator of formal versus informal employment. METHODS: The workers (n = 12 024) were surveyed in their homes. The age-adjusted prevalence of MSP during the previous month was calculated for pain in the back (upper, or cervical; middle, or thoracic; and lower, or lumbar) and arm joints (shoulder, elbow, and wrist). Prevalence was estimated by sex, occupation (manual or non-manual), economic sector (agriculture, industry, or services), and social security coverage. Poisson regression models were used to calculate the prevalence rates and 95% confidence intervals, with stratification by country and anatomical site. RESULTS: By sites, the age-adjusted prevalence of cervical-dorsal MSP was the highest, especially in El Salvador (47.8%) and Nicaragua (45.9%), and lumbar MSP was less prevalent, especially in Panama (12.8%) and Guatemala (14.8%). After additional adjustments, the prevalence of MSP was higher in women and manual workers for all the sites and in all the countries. There were no differences in MSP in terms of social security coverage or sector of economic activity. CONCLUSIONS: The high prevalence of MSP in Central America, regardless of sector of activity or social security coverage, indicates that the prevention of MSP should be a priority in occupational health programs in low- and middle-income countries, especially for women and manual workers.
Asunto(s)
Encuestas Epidemiológicas , Dolor Musculoesquelético/epidemiología , Ocupaciones , Adulto , América Central/epidemiología , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Persona de Mediana Edad , Dolor Musculoesquelético/economía , Especificidad de Órganos , Prevalencia , Seguridad Social/estadística & datos numéricosRESUMEN
BACKGROUND: Although vocational rehabilitation is a widely advocated intervention for workers on sick leave due to subacute or chronic nonspecific musculoskeletal pain, the optimal dosage of effective and cost-effective vocational rehabilitation remains unknown. The objective of this paper is to describe the design of a non-inferiority trial evaluating the effectiveness and cost-effectiveness of 40-h multidisciplinary vocational rehabilitation compared with 100-h multidisciplinary vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain. METHODS/DESIGN: A non-inferiority study design will be applied. The study population consists of workers who are on part-time or full-time sick leave due to subacute or chronic nonspecific musculoskeletal pain. Two multidisciplinary vocational rehabilitation programs following the bio-psychosocial approach will be evaluated in this study: 40-h vocational rehabilitation and 100-h vocational rehabilitation, both delivered over a maximum of 15 weeks. The 100-h vocational rehabilitation comprises five modules: work participation coordination, graded activity, cognitive behavioral therapy, group education, and relaxation. The 40-h vocational rehabilitation comprises work participation coordination and a well-reasoned choice from the other four modules. Four rehabilitation centers will participate in this study, each delivering both interventions. Patients will be randomized into one of the interventions, stratified for the duration of sick leave (<6 weeks or ≥ 6 weeks) and type of sick leave (part-time or full-time). The primary outcome is work participation, measured by self-reported sick leave days, and will be assessed at baseline, mid-term, discharge, and at 2, 4, 6, 8, 10, and 12 months follow-up. Secondary outcomes are work ability, disability, quality of life, and physical functioning and will be assessed at baseline, discharge, and at 6 and 12 months follow-up. Cost outcomes are absenteeism, presenteeism, healthcare usage, and travelling costs. Cost-effectiveness will be evaluated from the societal and employer perspectives. DISCUSSION: The results obtained from this study will be useful for vocational rehabilitation practice and will provide stakeholders with relevant insights into two versions of vocational rehabilitation. TRIAL REGISTRATION: Dutch Trial Register identifier: NTR4362 (registered 17 March 2014).
Asunto(s)
Dolor Crónico/economía , Dolor Crónico/rehabilitación , Costos de la Atención en Salud , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/rehabilitación , Salud Laboral/economía , Rehabilitación Vocacional/economía , Reinserción al Trabajo/economía , Ausencia por Enfermedad/economía , Absentismo , Adolescente , Adulto , Anciano , Dolor Crónico/diagnóstico , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Terapia Cognitivo-Conductual/economía , Análisis Costo-Beneficio , Femenino , Procesos de Grupo , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/fisiopatología , Dolor Musculoesquelético/psicología , Países Bajos , Educación del Paciente como Asunto/economía , Rehabilitación Vocacional/métodos , Terapia por Relajación/economía , Proyectos de Investigación , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. METHODS/DESIGN: This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. DISCUSSION: This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. TRIAL REGISTRATION: Current Controlled Trials ISRCTN52269669.
Asunto(s)
Consejo , Dolor Musculoesquelético/terapia , Enfermedades Profesionales/terapia , Servicios de Salud del Trabajador , Atención Primaria de Salud , Proyectos de Investigación , Absentismo , Manejo de Caso , Protocolos Clínicos , Análisis Costo-Beneficio , Consejo/economía , Inglaterra , Medicina General , Costos de la Atención en Salud , Humanos , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/economía , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/economía , Servicios de Salud del Trabajador/economía , Atención Primaria de Salud/economía , Años de Vida Ajustados por Calidad de Vida , Ausencia por Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.
Asunto(s)
Dolor Crónico/etiología , Dolor Musculoesquelético/etiología , Espondiloartritis/fisiopatología , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Antidepresivos/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/fisiopatología , Sensibilización del Sistema Nervioso Central/fisiología , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/economía , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Estudios Transversales , Diagnóstico Diferencial , Fatiga/etiología , Fibromialgia/diagnóstico , Fibromialgia/fisiopatología , Humanos , Dolor Musculoesquelético/tratamiento farmacológico , Dolor Musculoesquelético/economía , Dolor Musculoesquelético/fisiopatología , Dolor Musculoesquelético/psicología , Manejo del Dolor , Dimensión del Dolor , Calidad de Vida , Trastornos Intrínsecos del Sueño/etiología , Espondiloartritis/diagnóstico , Espondiloartritis/tratamiento farmacológico , Espondiloartritis/economíaRESUMEN
Chronic pain has been identified as an important issue related to various rheumatic diseases. At the time of a major government spending review, it is appropriate to discuss the pain characterising rheumatic diseases and its related costs. It is clearly essential for healthcare authorities to rationalise their policies on the basis of the increasing expectations of the users of healthcare services while simultaneously balancing their books. There are few published studies concerning the costs of pain of any kind, and the same is true of the costs of the chronic pain associated with diseases such as rheumatoid arthritis, osteoarthritis, and fibromyalgia.