Abstract | STUDY DESIGN: Decision analysis. OBJECTIVE: To identify the best treatment for nonspecific neck pain. SUMMARY OF BACKGROUND DATA: In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs ( NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. METHODS: (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. RESULTS: There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. CONCLUSION: When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.
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Authors | Gabrielle van der Velde, Sheilah Hogg-Johnson, Ahmed M Bayoumi, J David Cassidy, Pierre Côté, Eleanor Boyle, Hilary Llewellyn-Thomas, Stella Chan, Peter Subrata, Jan Lucas Hoving, Eric Hurwitz, Claire Bombardier, Murray Krahn |
Journal | Spine
(Spine (Phila Pa 1976))
Vol. 33
Issue 4 Suppl
Pg. S184-91
(Feb 15 2008)
ISSN: 1528-1159 [Electronic] United States |
PMID | 18204391
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
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Topics |
- Anti-Inflammatory Agents, Non-Steroidal
(adverse effects, therapeutic use)
- Cohort Studies
- Decision Support Techniques
- Exercise Therapy
(adverse effects, standards, statistics & numerical data)
- Female
- Humans
- Iatrogenic Disease
(epidemiology)
- Life Expectancy
(trends)
- Male
- Manipulation, Spinal
(adverse effects, standards, statistics & numerical data)
- Middle Aged
- Models, Statistical
- Neck Pain
(physiopathology, therapy)
- Patient Satisfaction
(statistics & numerical data)
- Quality of Life
- Randomized Controlled Trials as Topic
(statistics & numerical data)
- Risk Assessment
- Treatment Outcome
- Vertebrobasilar Insufficiency
(epidemiology, physiopathology)
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