professor at Harvard Medical School... in the July 1993issue of American Health said; "...only 3% of all back surgeries can be justified..." "97% are unnecessary!"
This randomized, controlled trial compared the efficacy of manual therapy, physiotherapy and general
practitioner care in reducing neck pain. One hundred eighty-three patients with neck pain of at least two
weeks' duration were randomly assigned to one of three groups: manual therapy (spinal mobilization);
physiotherapy (mainly exercise); or general practitioner care (counseling, education and analgesics).
Manual therapy consisted of a range of interventions: muscular mobilization, specific articular mobilization,
coordination or stabilization. Spinal mobilization was defined as low-velocity, passive movements within or
at the limit of joint range of motion.
Outcome measures included perceived recovery, intensity of pain, functional disability and quality of life;
direct and indirect costs were measured to determine mean costs between groups, overall
cost-effectiveness, and cost-utility ratios. Patients completed cost diaries for one year, providing data on
direct health care costs of practitioner care; additional visits to other health care providers; drugs;
professional home care; and hospitalization. Direct non-health care costs included out-of-pocket
expenses; paid and unpaid help; and travel expenses. Indirect costs (lost of production attributable to
work absenteeism or days of inactivity for those with or without a job) also were evaluated.
Results: Manual therapy was the most effective of the three treatments, with 68% of patients
demonstrating recovery after seven weeks, compared to 51% in the physiotherapy group and 36% in the
general practitioner group. These differences were significant at six-month follow-up. Manual therapy also
approximately one-third the costs of either physiotherapy or general practitioner care.
Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy,
and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.
British Medical Journal, April 26, 2003:326.