Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain
In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. I...
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| Veröffentlicht in: | American journal of epidemiology 2006-09, Vol.164 (5), p.487-496 |
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| creator | Witt, Claudia M. Jena, Susanne Selim, Dagmar Brinkhaus, Benno Reinhold, Thomas Wruck, Katja Liecker, Bodo Linde, Klaus Wegscheider, Karl Willich, Stefan N. |
| description | In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age = 52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference = 9.4 points (95% confidence interval 8.3, 10.5); p < 0.001). Nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients. The incremental cost-effectiveness ratio was €10,526 (euros) per quality-adjusted life year. Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective. |
| doi_str_mv | 10.1093/aje/kwj224 |
| format | Article |
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In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age = 52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference = 9.4 points (95% confidence interval 8.3, 10.5); p < 0.001). Nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients. The incremental cost-effectiveness ratio was €10,526 (euros) per quality-adjusted life year. Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective.</description><identifier>ISSN: 0002-9262</identifier><identifier>EISSN: 1476-6256</identifier><identifier>DOI: 10.1093/aje/kwj224</identifier><identifier>PMID: 16798792</identifier><identifier>CODEN: AJEPAS</identifier><language>eng</language><publisher>Cary, NC: Oxford University Press</publisher><subject>Acupuncture ; Acupuncture - economics ; Acupuncture - statistics & numerical data ; Analysis. Health state ; Back pain ; Benefit cost analysis ; Biological and medical sciences ; Chronic Disease ; Clinical trials ; complementary therapies ; confidence interval ; Cost-Benefit Analysis ; Diseases of the osteoarticular system ; Diseases of the spine ; Epidemiology ; Female ; General aspects ; Hannover Functional Ability Questionnaire ; health care economics and organizations ; HFAQ ; Humans ; low back pain ; Low Back Pain - economics ; Low Back Pain - therapy ; Male ; Medical Outcomes Study 36-Item Short Form ; Medical sciences ; Middle Aged ; Miscellaneous ; Pain management ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; QALY ; Quality of Life ; quality-adjusted life year ; Quality-Adjusted Life Years ; randomized controlled trials ; SF-36 ; standard deviation ; standard error</subject><ispartof>American journal of epidemiology, 2006-09, Vol.164 (5), p.487-496</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Sep 1, 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-2d8326d09e712217d44dbe6c5497069dbd2e19416aae4ad289dae89f1bfee70c3</citedby><cites>FETCH-LOGICAL-c482t-2d8326d09e712217d44dbe6c5497069dbd2e19416aae4ad289dae89f1bfee70c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18107547$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16798792$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Witt, Claudia M.</creatorcontrib><creatorcontrib>Jena, Susanne</creatorcontrib><creatorcontrib>Selim, Dagmar</creatorcontrib><creatorcontrib>Brinkhaus, Benno</creatorcontrib><creatorcontrib>Reinhold, Thomas</creatorcontrib><creatorcontrib>Wruck, Katja</creatorcontrib><creatorcontrib>Liecker, Bodo</creatorcontrib><creatorcontrib>Linde, Klaus</creatorcontrib><creatorcontrib>Wegscheider, Karl</creatorcontrib><creatorcontrib>Willich, Stefan N.</creatorcontrib><title>Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain</title><title>American journal of epidemiology</title><addtitle>Am. J. Epidemiol</addtitle><description>In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age = 52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference = 9.4 points (95% confidence interval 8.3, 10.5); p < 0.001). Nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients. The incremental cost-effectiveness ratio was €10,526 (euros) per quality-adjusted life year. Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective.</description><subject>Acupuncture</subject><subject>Acupuncture - economics</subject><subject>Acupuncture - statistics & numerical data</subject><subject>Analysis. Health state</subject><subject>Back pain</subject><subject>Benefit cost analysis</subject><subject>Biological and medical sciences</subject><subject>Chronic Disease</subject><subject>Clinical trials</subject><subject>complementary therapies</subject><subject>confidence interval</subject><subject>Cost-Benefit Analysis</subject><subject>Diseases of the osteoarticular system</subject><subject>Diseases of the spine</subject><subject>Epidemiology</subject><subject>Female</subject><subject>General aspects</subject><subject>Hannover Functional Ability Questionnaire</subject><subject>health care economics and organizations</subject><subject>HFAQ</subject><subject>Humans</subject><subject>low back pain</subject><subject>Low Back Pain - economics</subject><subject>Low Back Pain - therapy</subject><subject>Male</subject><subject>Medical Outcomes Study 36-Item Short Form</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Pain management</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>QALY</subject><subject>Quality of Life</subject><subject>quality-adjusted life year</subject><subject>Quality-Adjusted Life Years</subject><subject>randomized controlled trials</subject><subject>SF-36</subject><subject>standard deviation</subject><subject>standard error</subject><issn>0002-9262</issn><issn>1476-6256</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0VFrFDEQB_Agir2evvgBJAj6IKxNstlk81iPayscWLSK-BJyyWybu93kTHav6qc3cocF8xLI_DIM80foBSXvKFH1mdnA2fZ-wxh_hGaUS1EJ1ojHaEYIYZVigp2g05w3hFCqGvIUnVAhVSsVm6H9dTK3gxm9xZ9McHHwv8Hhm-RNj5d700-lFG7xeAd40fvgbXkvDi9tDAVbvOw6sKPfQ4CccezwuZ12U7DjlAB3MeHFXYrlH17Fe_ze2C2-Nj48Q08602d4frzn6MvF8mZxVa0-Xn5YnK8qy1s2Vsy1NROOKJCUMSod524NwjZcSSKUWzsGVHEqjAFuHGuVM9Cqjq47AElsPUdvDn13Kf6YII968NlC35sAccpatFKKupw5evUf3MQphTKbZnXT8kYyVdDbA7Ip5pyg07vkB5N-aUr03yh0iUIfoij45bHjtB7APdDj7gt4fQQml7V2yQTr84NrKZENl8VVB-fzCD__1U3aaiFr2eirb981-dxeEEW-alH_AeUzobY</recordid><startdate>20060901</startdate><enddate>20060901</enddate><creator>Witt, Claudia M.</creator><creator>Jena, Susanne</creator><creator>Selim, Dagmar</creator><creator>Brinkhaus, Benno</creator><creator>Reinhold, Thomas</creator><creator>Wruck, Katja</creator><creator>Liecker, Bodo</creator><creator>Linde, Klaus</creator><creator>Wegscheider, Karl</creator><creator>Willich, Stefan N.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20060901</creationdate><title>Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain</title><author>Witt, Claudia M. ; Jena, Susanne ; Selim, Dagmar ; Brinkhaus, Benno ; Reinhold, Thomas ; Wruck, Katja ; Liecker, Bodo ; Linde, Klaus ; Wegscheider, Karl ; Willich, Stefan N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-2d8326d09e712217d44dbe6c5497069dbd2e19416aae4ad289dae89f1bfee70c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Acupuncture</topic><topic>Acupuncture - economics</topic><topic>Acupuncture - statistics & numerical data</topic><topic>Analysis. Health state</topic><topic>Back pain</topic><topic>Benefit cost analysis</topic><topic>Biological and medical sciences</topic><topic>Chronic Disease</topic><topic>Clinical trials</topic><topic>complementary therapies</topic><topic>confidence interval</topic><topic>Cost-Benefit Analysis</topic><topic>Diseases of the osteoarticular system</topic><topic>Diseases of the spine</topic><topic>Epidemiology</topic><topic>Female</topic><topic>General aspects</topic><topic>Hannover Functional Ability Questionnaire</topic><topic>health care economics and organizations</topic><topic>HFAQ</topic><topic>Humans</topic><topic>low back pain</topic><topic>Low Back Pain - economics</topic><topic>Low Back Pain - therapy</topic><topic>Male</topic><topic>Medical Outcomes Study 36-Item Short Form</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Pain management</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>QALY</topic><topic>Quality of Life</topic><topic>quality-adjusted life year</topic><topic>Quality-Adjusted Life Years</topic><topic>randomized controlled trials</topic><topic>SF-36</topic><topic>standard deviation</topic><topic>standard error</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Witt, Claudia M.</creatorcontrib><creatorcontrib>Jena, Susanne</creatorcontrib><creatorcontrib>Selim, Dagmar</creatorcontrib><creatorcontrib>Brinkhaus, Benno</creatorcontrib><creatorcontrib>Reinhold, Thomas</creatorcontrib><creatorcontrib>Wruck, Katja</creatorcontrib><creatorcontrib>Liecker, Bodo</creatorcontrib><creatorcontrib>Linde, Klaus</creatorcontrib><creatorcontrib>Wegscheider, Karl</creatorcontrib><creatorcontrib>Willich, Stefan N.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Witt, Claudia M.</au><au>Jena, Susanne</au><au>Selim, Dagmar</au><au>Brinkhaus, Benno</au><au>Reinhold, Thomas</au><au>Wruck, Katja</au><au>Liecker, Bodo</au><au>Linde, Klaus</au><au>Wegscheider, Karl</au><au>Willich, Stefan N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain</atitle><jtitle>American journal of epidemiology</jtitle><addtitle>Am. J. Epidemiol</addtitle><date>2006-09-01</date><risdate>2006</risdate><volume>164</volume><issue>5</issue><spage>487</spage><epage>496</epage><pages>487-496</pages><issn>0002-9262</issn><eissn>1476-6256</eissn><coden>AJEPAS</coden><abstract>In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age = 52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference = 9.4 points (95% confidence interval 8.3, 10.5); p < 0.001). Nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients. The incremental cost-effectiveness ratio was €10,526 (euros) per quality-adjusted life year. Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective.</abstract><cop>Cary, NC</cop><pub>Oxford University Press</pub><pmid>16798792</pmid><doi>10.1093/aje/kwj224</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of epidemiology, 2006-09, Vol.164 (5), p.487-496 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Acupuncture Acupuncture - economics Acupuncture - statistics & numerical data Analysis. Health state Back pain Benefit cost analysis Biological and medical sciences Chronic Disease Clinical trials complementary therapies confidence interval Cost-Benefit Analysis Diseases of the osteoarticular system Diseases of the spine Epidemiology Female General aspects Hannover Functional Ability Questionnaire health care economics and organizations HFAQ Humans low back pain Low Back Pain - economics Low Back Pain - therapy Male Medical Outcomes Study 36-Item Short Form Medical sciences Middle Aged Miscellaneous Pain management Public health. Hygiene Public health. Hygiene-occupational medicine QALY Quality of Life quality-adjusted life year Quality-Adjusted Life Years randomized controlled trials SF-36 standard deviation standard error |
| title | Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain |
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