Neck pain service utilization and costs: association with number of visits of chiropractic manipulation, active care, manual therapy, or acupuncture. A retrospective cohort study

BackgroundNeck pain (NP) clinical practice guidelines (CPG) generally emphasize natural history, self-care, and non-pharmaceutical therapies. For non-pharmaceutical therapies provided for NP, like chiropractic manipulative treatment (CMT), active care (AC), manual therapy (MT), or acupuncture, little is known about the dose/response relationship with use of other services and total cost. The purpose of this retrospective cohort study of individuals with NP was to examine the dose response association between the number of visits of CMT, AC, MT, or acupuncture, the exposure to pharmaceutical, imaging, and interventional services, and total episode cost. MethodsEpisode of care was used to analyze a national sample of individuals 18 years and older with a single episode of non-surgical NP occurring in 2017-2019 and initially contacting a chiropractor (DC), physical therapist (PT), or licensed acupuncturist (LAc). The number of visits of CMT, AC, MT, or acupuncture were the primary independent variables. Rate and timing of use of 13 types of health care services and total episode cost were the primary dependent measures. ResultsA total of 91,805 continuously insured individuals initially contacted a DC, PT, or LAc for a single episode of non-surgical NP. These individuals initially contacted 19,387 different DCs, 1,828 PTs and 1,153 LAcs. There were $39,150,944 in total expenditures. The most common number of visits was 1 to 3 for CMT (47.8% of episodes), AC (31.8%), and MT (35.0%), and 4 to 6 for acupuncture (27.5%). Different levels of utilization intensity of CMT, AC, MT, and acupuncture were generally not associated with statistically or clinically meaningful differences in exposure to pharmaceutical, imaging, or interventional services. Total episode cost increased with higher numbers of visits of CMT, AC, MT, and acupuncture with CMT associated with the lowest median total episode code at each level of visit utilization. ConclusionsFor individuals with non-surgical NP initially contacting a DC, PT or LAc, 1 to 3 visits of CMT, AC, or MT, and 4 to 6 visits of acupuncture were the most common levels of utilization. A higher number of visits of CMT, AC, MT or acupuncture was associated with significantly higher total cost, without clinically or statistically meaningful differences in exposure to pharmaceutical, imaging, or interventional services. CMT was associated with the lowest total episode cost at each level of utilization. Higher visit counts of CMT, AC, MT, or acupuncture may have been associated with unmeasured clinical benefits and warrants further study.