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The Somatic Connection  |   May 2017
Cost-Effective Management of Low Back and Joint Pain by Specialty
Author Notes
  • Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   May 2017
Cost-Effective Management of Low Back and Joint Pain by Specialty
The Journal of the American Osteopathic Association, May 2017, Vol. 117, 332. doi:10.7556/jaoa.2017.060
The Journal of the American Osteopathic Association, May 2017, Vol. 117, 332. doi:10.7556/jaoa.2017.060
Wilson FA, Licciardone JC, Kearns CM, Akuoko M. Analysis of provider specialties in the treatment of patients with clinically diagnosed back and joint problems. J Eval Clin Pract. 2015;21(5):952–957. doi:10.1111/jep.12411 
Back and joint pain are common ailments that are managed by various health care professionals. Researchers at the University of Nebraska Medical Center in association with The Osteopathic Research Center at the University of North Texas Health Science Center compared the cost-effectiveness of improving patient outcomes across specialties with average total costs of treatments from health care professionals. The researchers used data from the Medical Expenditure Panel Survey, which is a nationally represented survey that collects data on respondents’ health status and health care use and expenditures conducted by the Agency for Healthcare Research and Quality. To assess health benefit, self-reported measures of physical health and mental health were analyzed to derive EuroQol-5D (EQ-5D) index scores, which measure the health-related quality of life domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. 
A total of 16,546 Medical Expenditure Panel Survey respondents from 2002 to 2012 who had at least 1 office-based health care professional visit for a diagnosed low back or joint problem were included in the study. All respondents included were aged 18 years or older. Respondents who received treatment for back or joint pain from more than 1 health care professional were excluded. The study compared physicians in the following specialties: osteopathic medicine, internal medicine, orthopedics, rheumatology, neurology, family/general practice, and nonphysician health care professionals: chiropractors, physical therapists, acupuncturists, and massage therapists. The age-adjusted results, based on incremental cost-effectiveness ratios using the EQ-5D index scores, showed that osteopathic medicine, family medicine, and internal medicine were the most cost-effective. Chiropractors, physiotherapists, acupuncturists, and physicians in the specialties of orthopedics, neurology, and rheumatology were not cost-effective. 
In summary, for patient-reported overall health based on combined physical and mental components, the specialties of family medicine, osteopathic medicine, and internal medicine were the most cost-effective in treating low back and joint pain.