Evidence map›Paper›PMID 40849676›Full record

SynthesisChiropractic & manual therapies2025

Cost-effectiveness of spinal manipulation, exercise, and self-management for spinal pain.

Brent D Leininger, Karen M Kuntz, James S Hodges, Roni Evans, Eva Enns, Pamela Jo Johnson, Gert Bronfort

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Chiropractic & manual therapies, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Brent D LeiningerIntegrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA. lein0122@umn.edu.
Karen M KuntzDivision of Health Policy & Management School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729 Mayo, Minneapolis, MN, 55455, USA.
James S HodgesDivision of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200 University Office Plaza, Minneapolis, MN, 55414, USA.
Roni EvansIntegrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA.
Eva EnnsDivision of Health Policy & Management School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729 Mayo, Minneapolis, MN, 55455, USA.
Pamela Jo JohnsonDepartment of Public Health, North Dakota State University, 640R Aldevron Tower, 1455 14th Ave N, Fargo, ND, 58102, USA.
Gert BronfortIntegrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA.

Funding

Cost effectiveness of manipulation for spine pain using individual patient dataK01AT008965 · NCCIH · UNIVERSITY OF MINNESOTA · PI LEININGER, BRENT · 2016 to 2020
$559k
NCCIH NIH HHS K01 AT008965NCCIH NIH HHS K01AT008965
6 · The paper itself

Abstract

backgroundThe United States spends more money on the care of back and neck pain than any other health condition. Despite this, the cost-effectiveness for many recommended treatments is unclear. Our primary objective for this project was to estimate the cost-effectiveness of spinal manipulative therapy (SMT), supervised exercise therapy (ET), and home exercise and advice (HEA) for spinal pain in the U.S.

methodsWe analyzed cost and clinical outcome data from eight randomized trials conducted in the U.S. using an individual participant data meta-analysis approach. We calculated cost-effectiveness from the societal and healthcare perspective of various comparisons between SMT, ET, and HEA. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life years as the main outcome.

resultsThe trials included a total of 1803 participants and 1488 (83%) provided complete data. Incremental cost-effectiveness ratios and probabilities of cost-effectiveness varied substantially between studies; thus, we did not conduct meta-analysis and report findings from individual trials. Cost-effectiveness findings were favorable for SMT compared to HEA for acute neck pain (ICERs below $50k/QALY) and when added to HEA for chronic back-related leg pain and chronic neck pain in older adults (better outcomes and lower costs). However, SMT was not likely cost-effective compared to HEA for chronic back pain in adults or when added to HEA for older adults (higher costs and worse outcomes). Findings for SMT were favorable when compared to ET in adults with chronic back pain and when added to ET for chronic neck pain in adults (better outcomes and lower costs) and chronic back pain in adolescents (ICERs below $50k/QALY). However, SMT is not likely cost-effective when compared to ET for chronic neck pain in adults (ICERs below $70k/QALY for exercise) and findings were inconsistent across outcomes in older adults with chronic back pain. Finally, ET may be cost-effective compared to HEA for adults with chronic neck pain (ICERs largely between $100-$200k/QALY), but not for chronic back pain or when added to HEA for older adults with chronic neck or back pain (higher costs and worse outcomes). DISCUSSION: Cost-effectiveness findings differed between populations based on pain location, duration, and age.

Indexed as

Back PainExercise TherapyManipulation, SpinalNeck PainSelf-ManagementAdultCost-Benefit AnalysisFemaleHumansMaleMiddle AgedQuality-Adjusted Life YearsRandomized Controlled Trials as TopicUnited StatesBack painCost-effectivenessExerciseNeck painSelf-managementSpinal manipulation

Identifiers

PMID40849676
PMCPMC12375277

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.