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We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year.
The interventions were ranked according to quality adjusted life years Deep Tissue Massage Stockholm in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.
Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 EUR per year in full health gained. Massage and a combined therapy are not cost-effective. Advice to stay active remains as a good therapeutic alternative from an economical perspective.
A combined therapy is not cost-effective compared to advice for persistent Kuwait Airways Hijack pain. Advice is a good alternative for persistent neck pain from an economic perspective. Neck pain is a leading cause of disability worldwide and it is especially high among people between 25 and 64 years old. Health care costs are higher for care related to subacute and chronic then for acute neck pain.
The evidence suggest that non-pharmacological therapies are effective for the clinical management of neck and associated disorders. Few studies have evaluated the cost-effectiveness of non-pharmacological therapies and none have specifically evaluated massage for neck pain from an economical perspective.
The existing evidence regarding its cost-effectiveness is inconclusive. Nonetheless, massage for low back pain has been shown not to be cost-effective when provided alone, but it is cost-effective when combined with exercises. On the other hand, exercises provided alone or in combination with advice are cost-effective for neck pain.
In addition, one session of education is cost-effective for whiplash associated disorders. An economic evaluation of these types of therapies for disabling non-specific neck pain is warranted. This study evaluates the cost-effectiveness of deep tissue massage, strengthening and stretching exercises, or a combination of both compared with advice to stay active for subacute and persistent non-specific neck pain from a societal perspective.
We conducted the Stockholm Neck STONE trial, a randomized controlled trial to determine the effectiveness of deep tissue massage therapy hereafter massagestrengthening and stretching exercises hereafter exercisesa combination of deep tissue massage and strengthening and stretching exercises hereafter combined therapycompared with advice to stay active.
A study coordinator prepared blocks of sequentially numbered sealed envelopes 40 for each intervention. The intervention was revealed after baseline assessment at the research clinic. Blinding of participants or therapists was not possible due to the nature of the interventions. The recruitment and data collection occurred between Nov and Nov The sample size was calculated to detect a relative risk of 1.
The Mulatt Bebis underwent training sessions 3-h sessions twice and regular supervision to ensure a standardized provision of all the interventions in the STONE trial.
The number of sessions followed the usual practice in primary care in Sweden and were considered to be sufficient to achieve the purpose of the interventions; up to six sessions within six weeks were offered to the participants in the massage, exercises and combined therapy groups and up to three sessions in the advice to stay active group.
All the sessions were provided individually. Exercises targeted the following muscle groups: deep flexors of the neck, chest musculature, scapula musculature, jaw musculature and extensors Deanna Russo Married the neck. The sessions lasted 35 min on average.
In addition Deep Tissue Massage Stockholm the supervised sessions, participants were advised to repeat the Deep Tissue Massage Stockholm exercises at home.
To facilitate that the execution of the exercises followed a proper technique, they were filmed with their own smartphone during the supervised sessions. The components of the deep tissue massage therapy were: massage of muscles of the neck, upper back, jaw and Deep Tissue Massage Stockholm, as well as management of active and latent points producing concordant signs and stretching of chest.
The combined therapy started with the same techniques as in the exercises groups and finished with the techniques in the massage group. Similar to Deep Tissue Massage Stockholm exercises group, in addition to the supervised sessions, participants were advised to repeat the provided exercises at home. Sessions lasted 50 min divided equally to the two modalities. The intervention in the advice group consisted of a motivating discussion using evidence-based information on spinal pain in addition to an educational booklet.
The advice group was the control group. Sessions lasted 20—25 min. Participants filled out questionnaires at baseline, seven weeks, three months, six months and one year. We measured health-related quality Deep Tissue Massage Stockholm life using the EQ-5D-3L questionnaire not measured at seven weeksand based on this, utility was calculated using Swedish experience-based utility values using the time trade-off method.
Pain intensity and pain-related disability were measured with numerical rating scales NRS from the Chronic Pain Questionnaire ; information on perceived recovery as well as sickness absence were also collected. These outcomes were, however, not included in the economic evaluation.
We collected information on direct medical costs interventions, appointments with different health providers and prescribed drugsdirect non-medical costs over the counter medication, naturopathic medication and time allocated to attend appointments and indirect costs sickness absence. Costs used in the economic evaluation were calculated as Deep Tissue Massage Stockholm product of items of resources used.
The unit cost of each type of item associated with the therapy as described in the section below. Direct medical and non-medical costs were calculated by multiplying the number of each resource use at the individual level with its corresponding unit cost.
No hospitalizations costs were recorded. Visits to physiotherapists and medical doctors are subsidized by the Swedish healthcare system and patients usually pay a copayment only. We assigned the fee paid by the patients plus the compensation given by the city council. The cost of the interventions in the trial were obtained from market prices of visits to naprapaths, depending on the duration of Deep Tissue Massage Stockholm intervention, rather than from a direct calculation based on salaries, overhead costs, supplies and others, since that information was not available.
The cost of imaging was calculated from the average of the market prices in Stockholm. For naturopathic medications, price information was obtained from the local and online retailers and assigned to each participant individually. The Swedish healthcare system subsidizes prescribed medications, imaging and appointments with medical doctors, physiotherapists and, to some extent, psychotherapists high-cost threshold in order to protect patients from Läckta Nakenbilder expenditures.
This reduction in costs was taken into account during the cost calculations. Indirect costs were included in terms of losses to paid production i.
Participants reported the number of days they had been off work due to neck Jessica Lowndes Kiss. We multiplied the number of days off work by the Faye Runaway Videos salary based on the self-reported occupation.
Students and pensioners were assigned zero as value and volunteer time was deemed minimal. Since we did not have specific information on means of transportation to and from the clinic or whether they used that time from work or leisure timeno costs for that concept were assigned. However, overtime cost was used for the time invested in attending appointments, both the ones provided as part of the trial and Collar Bdsm Porn ones incurred by the participants after that.
This implies that all relevant costs and effects of the intervention and non-specific neck pain are Joanna Jedrzejczyk Boob Job, regardless of who pays or benefits.
An intention to treat principle was followed. Costs and benefits were analyzed within one Babylights Brunette horizon the RCT followed participants for one year. No discounting was applied. Quality of life is measured between 0 and 1. A QALY is equivalent to one year in perfect health. Thereafter, a cost-consequence analysis was performed in order to trim off strongly dominated alternatives, ranked by QALYs.
If one of the interventions resulted in larger effects and higher cost than the next one in the QALYs-based rank, the relative cost-effectiveness of the intervention was calculated in terms of incremental cost-effectiveness ratio ICER by dividing the incremental costs by the incremental QALYs.
In order to account for the missing values in costs and QALYs, we did multiple imputation using QALYs at baseline baseline utility and provided intervention as Deep Tissue Massage Stockholm. We used predictive mean matching to impute QALYs and a regression function to impute data on costs. The economic value of providing an intervention was represented by the ICER.
The differences in costs and QALYs between therapies was visually represented in a cost-effectiveness plane by using bootstrapping with replications. Seemingly unrelated regression was used to calculate the bootstrapped total costs and QALYs. To summarize the impact Jeny Smith Crotchless uncertainty on the ICER, a cost-effectiveness acceptability curve CEAC was used to show the probability that the intervention will be cost-effective at different willingness to pay thresholds.
All analyses were performed using Microsoft Excel and Stata An a posteriori sensitivity analysis was performed by excluding the costs from sickness absence. We observed that this item showed the highest difference between therapies. This supported the decision for conducting the sensitivity analysis. After assessment of eligibility, Swingersakce Full were included in the study Fig. After randomization, subjects were allocated to the massage group, to the exercises group, to the combined therapy group and to the advice group.
The advice group had lower proportion of persons reporting at least one day of sickness absence related to neck pain in the past six months Table 1. Deep tissue massage, strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain: A cost-effectiveness analysis of the Stockholm Neck trial STONE. Methods We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of participants followed-up for one year.
Conclusions Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 EUR per year in full health gained. A typical month was assumed to consist of 21 working days or h.
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Deep tissue strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain: A cost-effectiveness analysis of the Stockholm Neck trial (STONE) Musculoskelet Sci Pract. Apr;46 Author: Oscar Javier Pico-Espinosa, Emmanuel Aboagye, Pierre Côté, Anna Peterson, Lena W. Holm, Irene Jensen.
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We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year. The interventions were ranked according to quality adjusted life years QALYs in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.