KMCRIC

Effectiveness and Cost-Effectiveness of Tuina for Chronic Neck Pain: A Randomized Controlled Trial Comparing Tuina with a No-Intervention Waiting List.

Pach D, Piper M, Lotz F, Reinhold T, Dombrowski M, Chang Y, Liu B, Blödt S, Rotter G, Icke K, Witt CM.

J Altern Complement Med.

2018

24(3)

231-7.

10.1089/acm.2017.0209.

29072931

http://www.ncbi.nlm.nih.gov/pubmed/29072931

Adult
Chronic Pain/economics
Chronic Pain/therapy*
Cost-Benefit Analysis
Female
Humans
Male
Massage*
Medicine, Chinese Traditional/methods
Middle Aged
Neck Pain/economics
Neck Pain/therapy*
Treatment Outcome
Waiting Lists

neck pain; tuina; massage; medicine; Chinese Traditional Medicine

목 통증; 추나; 마사지; 의학; 중의학

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OBJECTIVE:
To evaluate whether tuina is more effective and cost-effective in reducing pain compared to no intervention in patients with chronic neck pain.

DESIGN:
Single-center randomized two-armed controlled trial.

SETTING:
University outpatient clinic specialized in Integrative Medicine.

SUBJECTS:
Outpatients with chronic neck pain were randomly allocated to tuina or no intervention.

INTERVENTION:
Six tuina treatments within 3 weeks.

OUTCOME MEASURES:
The primary outcome was the mean neck pain intensity during the previous 7 days on a visual analogue scale after 4 weeks (VAS, 0-100 mm, 0 = no pain, 100 = worst imaginable pain). Secondary outcomes included Neck Pain and Disability Scale (NPDS), Neck Disability Index (NDI), health-related quality of life (12-item quality-of-life questionnaire [SF-12]), medication intake, and cost-effectiveness after 4 and 12 weeks. Statistical analysis included analysis of covariance adjusted for baseline values and a full economic analysis from a societal perspective.

RESULTS:
Altogether, 92 outpatients were included (46 in both groups, 87% female, mean age 45.4 [standard deviation ±9.7], and mean VAS 57.7 ± 11.5). Tuina treatment led to a clinically meaningful reduction in neck pain intensity (group differences, 4 weeks: -22.8 mm [95% confidence interval, -31.7 to -13.8]; p < 0.001 and 12 weeks: -17.9 mm [-27.1 to -8.8], p < 0.001). No serious adverse events were observed. Total costs as well as quality-adjusted life years (QALYs) did not differ significantly between the groups. When taking group differences into account independently from their statistical significance, costs per QALY gained (incremental cost-effectiveness ratio) would range within a cost-effective area from €7,566 (for costs €10.28 per session) to €39,414 (cost €35 per session).

CONCLUSION:
An additional treatment with six tuina sessions over 3 weeks was effective, safe and relatively cost-effective for patients with chronic neck pain. A future trial should compare tuina to other best care options.

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