JAMA study describes two conservative interventions that effectively treat acute and subacute spine pain

The multidisciplinary biopsychosocial intervention known as ICE that includes physical therapy resulted in no significant difference in spine-related health care spending compared to usual care. IPT intervention led to significantly higher spine-related healthcare spending in one year. The findings of the SPINE CARE randomized controlled trial were featured in the Journal of the American Medical Association (JAMA).

Previous studies have reported that neck and low back pain are often self-limited, but healthcare spending remains high. Considering this, Niteesh K. Choudhry from the Harvard Medical School in Boston, Massachusetts, and colleagues aimed to assess the effects of 2 interventions that stress non-invasive care for spine pain. They addressed the question, "Does an individualized postural therapy or multidisciplinary biopsychosocial intervention reduce health care spending and improve disability among patients with acute or subacute spine pain?

The trial, conducted at 33 centres in the US, enrolled 2971 participants with neck or back pain for three months or less from 2017 to 2020; the final follow-up was in March 2021. Participants were randomized at the clinic level; 992 to usual care; 829 to a risk-stratified, multidisciplinary intervention (the ICE care model that combines health coach counseling, physical therapy and consultation from a pain medicine or rehabilitation specialist); and 1150 to individualized postural therapy, a postural therapy approach that combines building self-management and self-efficacy with physical therapy.

Change in ODI (Oswestry Disability Index) score at three months; it ranges from 0 being the best to 100 being the worst, and spine-related health care spending at one year was determined (primary outcomes).

The authors reported the following findings:

• Among 2971 randomized participants (mean age, 51.7 years; 60.3% were women), 92% completed the trial.
• Mean ODI scores changed from 29.3 to 15.4 for IPT, 31.2 to 15.4 for ICE, and 28.9 to 19.5 for usual care Between baseline and 3-month follow-up.
• Absolute differences compared with usual care were −4.3 for IPT and −5.8 for ICE at 3-month follow-up.
• Mean 12-month spending was $2528, $1448, and $1587 in the IPT, ICE, and usual care groups, respectively.
• Spending differences compared with usual care were $941 (risk ratio, 1.40) for IPT and −$139 (risk ratio, 0.93) for ICE.

The study revealed that both a biopsychosocial and IPT intervention resulted in a modest statistically significant decrease in disability at three months compared with usual care; however, the postural therapy intervention resulted in more lavish spending, and the biopsychosocial intervention resulted in no significant difference in spending at one year.

Reference:

Choudhry NK, Fifer S, Fontanet CP, et al. 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. JAMA. 2022;328(23):2334–2344. doi:10.1001/jama.2022.22625