Mbada CE1, Akano OT1, Kolade AA2, Odole AC3, Fatoye C4, Oyewole O5, Fatoye F6
1Obafemi Awolowo University, Medical Rehabilitation, Ile Ife, Nigeria, 2Obafemi Awolowo University Teaching Hospitals Complex, Physiotherapy, Ile Ife, Nigeria, 3University of Ibadan, Physiotherapy, Ibadan, Nigeria, 4Manchester Metropolitan University, Nursing, Manchester, United Kingdom, 5General Hospital Shagamu, Olabisi Onabanjo University Teaching Hospital, Physiotherapy, Sagamu, Nigeria, 6Manchester Metropolitan University, Health Professions, Manchester, Nigeria
Background: There is substantial evidence on efficacy of spinal manipulation from randomized trials (RCTs), thought to be the gold standard in healthcare research. However, the generalizability of the findings of RCTs to patient care in the 'real-world' may be limited as they are generally conducted under controlled conditions on a small sample over a short period. In addition, the costs of running RCTs can be substantial and there has been increased demand for value for money on healthcare including physiotherapy interventions. Therefore, the use of routinely collected data such as patient clinical records is an innovative ways of generating insights into the effectiveness of healthcare interventions in real-world.
Purpose: This study examined the real-world outcomes of Vertical Oscillatory Pressure (VOP) in low-back pain (LBP).
Methods: This was a retrospective study comparing the outcomes of patients attending a selected physiotherapy clinic at a tertiary teaching hospital in Nigeria who received VOP (n = 201) for their LBP with controls (n = 138) who had traditional physiotherapy (TP) in a routine clinical setting. Data were extracted from clinical records of the patients form June 1, 2009 to May 31, 2018. Information on pain and disability using verbal rating scale and Roland Morris Disability Questionnaire, respectively was extracted from the clinical records. Total costs of care was estimated in terms of direct and indirect costs. Data was summarized with descriptive statistics of mean and standard deviation. Repeated measures ANOVA and independent t-test were used for within and between group analysis, respectively with set at p 0.05.
Results: A total of 339 patients' records were included (VOP, 201; TP, 138). There were statistical significant differences within group (from baseline, 4th and 8th week) for the VOP group in pain levels (6.73 ± 1.56 vs. 4.60 ± 1.50 vs. 2-95 ± 1.37; p = 0.001) and disability (13.6 ± 2.64 vs. 7.03 ± 2.30 vs. 5.43 ± 2.54; p = 0.001). However, there was no within group difference in TP group in pain levels and disability across the weeks (p > 0.05). There was a significant difference in pain (3.79 ± 1.41 vs. 1.75 ± 2.90; p = 0.001) between VOP and TP at week eight but none on disability (p > 0.05). Higher but not significant direct ($20.98 ± 9.91 vs. $19.05 ± 9.03; p = 0.069) and indirect ($83.94 ± 39.64 vs. 76.22 ± 36.22; p = 0.065) costs were associated with VOP compared with TP.
Conclusion(s): The findings of the present study suggest that VOP is an effective intervention for LBP in 'real-world'. VOP is superior to TP on its effect on pain over time but comparable on disability. The costs of delivering VOP was higher than TP in real-world. The findings of the present study may inform clinical decisions to improve the health outcomes of patients with LBP. Future studies are required to examine the cost-effectiveness of the intervention.
Implications: The study may inform clinical decisions to improve the health outcomes of patients with LBP. Future studies are required to examine the cost-effectiveness of the intervention.
Keywords: Real world evidence, low back pain, cost
Funding acknowledgements: There was no funding received in relation to the study.
Purpose: This study examined the real-world outcomes of Vertical Oscillatory Pressure (VOP) in low-back pain (LBP).
Methods: This was a retrospective study comparing the outcomes of patients attending a selected physiotherapy clinic at a tertiary teaching hospital in Nigeria who received VOP (n = 201) for their LBP with controls (n = 138) who had traditional physiotherapy (TP) in a routine clinical setting. Data were extracted from clinical records of the patients form June 1, 2009 to May 31, 2018. Information on pain and disability using verbal rating scale and Roland Morris Disability Questionnaire, respectively was extracted from the clinical records. Total costs of care was estimated in terms of direct and indirect costs. Data was summarized with descriptive statistics of mean and standard deviation. Repeated measures ANOVA and independent t-test were used for within and between group analysis, respectively with set at p 0.05.
Results: A total of 339 patients' records were included (VOP, 201; TP, 138). There were statistical significant differences within group (from baseline, 4th and 8th week) for the VOP group in pain levels (6.73 ± 1.56 vs. 4.60 ± 1.50 vs. 2-95 ± 1.37; p = 0.001) and disability (13.6 ± 2.64 vs. 7.03 ± 2.30 vs. 5.43 ± 2.54; p = 0.001). However, there was no within group difference in TP group in pain levels and disability across the weeks (p > 0.05). There was a significant difference in pain (3.79 ± 1.41 vs. 1.75 ± 2.90; p = 0.001) between VOP and TP at week eight but none on disability (p > 0.05). Higher but not significant direct ($20.98 ± 9.91 vs. $19.05 ± 9.03; p = 0.069) and indirect ($83.94 ± 39.64 vs. 76.22 ± 36.22; p = 0.065) costs were associated with VOP compared with TP.
Conclusion(s): The findings of the present study suggest that VOP is an effective intervention for LBP in 'real-world'. VOP is superior to TP on its effect on pain over time but comparable on disability. The costs of delivering VOP was higher than TP in real-world. The findings of the present study may inform clinical decisions to improve the health outcomes of patients with LBP. Future studies are required to examine the cost-effectiveness of the intervention.
Implications: The study may inform clinical decisions to improve the health outcomes of patients with LBP. Future studies are required to examine the cost-effectiveness of the intervention.
Keywords: Real world evidence, low back pain, cost
Funding acknowledgements: There was no funding received in relation to the study.
Topic: Musculoskeletal: spine; Musculoskeletal; Globalisation: health systems, policies & strategies
Ethics approval required: Yes
Institution: Obafemi Awolowo University
Ethics committee: Approval from Health Research Ethical Committee Institute of Public Health
Ethics number: IPHOAU/12/945
All authors, affiliations and abstracts have been published as submitted.
