[Naturopathic and orthopaedic in-patient treatment of chronic back pain--a comparison study]

BACKGROUND

This study compares orthopaedic and naturopathic inpatient treatment concepts for back pain with regards to therapeutic efficacy.

PATIENTS AND METHODS

A controlled prospective cohort study is presented. 187 conservatively treated patients of an orthopaedic clinic and 161 patients of a clinic for naturopathy were recruited for the study, if they needed inpatient treatment because of chronic back pain.The results were measured with the Oswestry Score for orthopaedic symptoms as primary endpoint and the SF-36 for life quality before treatment (T0), after 3 (T2) and 6 months (T3), plus the SES for pain intensity and pain quality (T0, T1 = at discharge, T2, T3). Accompanying diseases were documented with anamnesis and catamnesis sheets. The whole collectives were evaluated. Additionally a gender specific analysis was performed.

RESULTS

For the main and secondary objectives no differences between the naturopathic and orthopaedic treatment groups (screened patients with back pain for naturopathy 286, 187 for orthopedics, in the study included patients 161 respectively 140 after 2 weeks, 62 respectively 68 after 6 months; mean age 57.1 respectively 54.0 years, female 85.1 respectively 63.6%) could be verified (Oswestry Score at T0: 43.0, 95%-confidence-interval 39.6-45.3; at T2: 40.7, 95%-confidence-interval 37.4-44.0). Only in the subgroup of women, who account for 86% of the naturopathic patients, a difference in the main objective (Oswestry Score) was found (p = 0.014) in favour of naturopathy (T2: 32.6, 95%-confidence-interval 24.9-40.2) compared to orthopedics (T2: 45.1,95%-confidence-interval 41.2-49.1).

CONCLUSION

Treatment results of naturopathic, complex" inpatient treatment of chronic back pain are comparable to conventional orthopaedic treatment at all points of time T1 to T3. The study design does not allow the conclusion, that the therapeutical concept can be changed forthetwo groups of patients with the same chance of good therapeutical efficacy. The result of the study is limited in this respect as the therapeutic effect cannot be claimed to be the same if the treatment groups were exchanged. Thus the improvement is only comparable.

[Comparison of treatment expenses of naturopathic and orthopedic in-patient treatment]

BACKGROUND

In health services research comparative studies between orthopaedics and naturopathy are necessary. They allow evidence based decisions between individual therapeutical alternatives as well as decisions on health politics, e.g. concerning allocation of resources.

PATIENTS AND METHODS

A controlled prospective cohort study is presented. Conservatively treated patients were recruited for the study, if they needed in-patient treatment because of chronic back pain. The conservative orthopaedic treatment including Minimal invasive Therapy (MIT) was compared to in-patient naturopathic "complex"-treatment. The real costs to the public health insurance system are unknown--relating to both the individual patient and the physician. Hence an approximation was attempted on the basis of the billing of the concerned hospitals, the analysis of extensive patient interviews, randomly selected evaluation of in- and out-patient records, validated by an expert panel.

RESULTS

Costs for medication decreased in the post stationary phase after orthopedic and naturopathic treatment. Rehabilitation measures and treatments at a health resort increased after orthopedic treatment, whereas the frequency of specialist consultation decreased in both cohorts indicating the efficacy of the in-patient treatment. Incidence of psychotherapy was highest in the naturopathic group before admission to hospital and decreased afterwards. The gathered data point to a reduction of the total outpatient treatment costs in both cohorts. There were treatment-specific differences when regarding single components.

CONCLUSION

Naturopathic complex in-patient treatment is a cost-efficient complement of the conventional orthopedic treatment options.