Addition of choice of complementary therapies to usual care for acute low back pain - A randomized controlled trial

Study Design. A randomized controlled trial. Objective. To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP). Summary of Background Data. Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies. Methods. A total of 444 patients with acute LBP (< 21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization. Results. After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of $244 per patient. This consisted of a $99 reduction in the average cost to the insurer for medical care but an additional cost of $343, for an average of 6.0 complementary and alternative medicine treatments per patient. Conclusions. A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.