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In people having acute or subacute spine pain, both biopsychosocial intervention and postural therapy intervention considerably decreased pain-related disability at 3 months when compared to usual care.
According to the findings of the SPINE CARE randomized clinical trial, individualized postural therapy (IPT) and a multidisciplinary biopsychosocial intervention with physical therapy (identify, coordinate, and enhance [ICE]) reduce spine pain-associated disability. This pragmatic cluster study that enrolled 2971 people having neck or back pain of three months’ duration or less sought to determine the effects of two interventions that emphasize non-invasive care for spine pain.
Volunteers were randomly allocated at the clinic-level to: (A) Risk-stratified, multidisciplinary intervention (ICE care model that blends health coach counseling, physical therapy, and consultation from an expert in pain medicine or rehabilitation) (n = 829); (B) IPT, a postural therapy strategy that blends physical therapy along with building self-management and self-effectiveness (n = 1150), and (C) Usual care (n = 992).
The key endpoints were alteration in the Oswestry Disability Index (ODI) score at three months (range: 0 [best] to 100 [worst]; minimal clinically important difference: 6) and spine-associated medical care spending at one year. A 2-sided significance threshold of .025 was used for defining statistical significance. The study was finished by 2733 (92%) of the 2971 randomized individuals (mean age, 51.7 years; 1792 women [60.3%]). Between the baseline and the three-month follow-up, the mean ODI scores for ICE, IPT, and usual care decreased from 31.2 to 15.4, 29.3 to 15.4, and 28.9 to 19.5, respectively. Absolute differences at three-month follow-up compared to standard care were -5.8 for ICE and -4.3 for IPT.
In ICE, IPT, and normal care arms, the mean twelve-month expenditures were $1448, $2528, and $1587, respectively. Spending differences for ICE were -$139 (risk ratio, 0.93); and for IPT, $941 (risk ratio, 1.40). A multidisciplinary biopsychosocial intervention or an IPT intervention, each compared with standard treatment, resulted in minor but substantial decreases in pain-associated disability among patients having acute or subacute spine pain at three months. Although the posture therapy intervention resulted in significantly higher spine-linked healthcare spending at one year, the biopsychosocial intervention had no discernible impact on the amount spent on spine-linked healthcare when compared to standard care.
JAMA
Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain The SPINE CARE Randomized Clinical Trial
Niteesh K. Choudhry et al.
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