Physician-Related Variability in the Outcomes of an Invasive Treatment for Neck and Back Pain: A Multi-Level Analysis of Data Gathered in Routine Clinical Practice

Ana Royuela, Francisco M. Kovacs, Jesús Seco-Calvo, Borja M. Fernández-Félix, Víctor Abraira and Javier Zamora
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Ana Royuela: CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
Francisco M. Kovacs: Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 Madrid, Spain
Jesús Seco-Calvo: Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 Madrid, Spain
Borja M. Fernández-Félix: CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
Víctor Abraira: Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 Madrid, Spain
Javier Zamora: CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain

IJERPH, 2021, vol. 18, issue 8, 1-20

Abstract: Neuro-reflexotherapy (NRT) is a proven effective, invasive treatment for neck and back pain. To assess physician-related variability in results, data from post-implementation surveillance of 9023 patients treated within the Spanish National Health Service by 12 physicians were analyzed. Separate multi-level logistic regression models were developed for spinal pain (SP), referred pain (RP), and disability. The models included all patient-related variables predicting response to NRT and physician-related variables. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were calculated. Adjusted MOR (95% CI) was 1.70 (1.47; 2.09) for SP, 1.60 (1.38; 1.99) for RP, and 1.65 (1.42; 2.03) for disability. Adjusted ICC (95%CI) values were 0.08 (0.05; 0.15) for SP, 0.07 (0.03; 0.14) for RP, and 0.08 (0.04; 0.14) for disability. In the sensitivity analysis, in which the 6920 patients treated during the physicians’ training period were excluded, adjusted MOR was 1.38 (1.17; 1.98) for SP, 1.37 (1.12; 2.31) for RP, and 1.25 (1.09; 1.79) for disability, while ICCs were 0.03 (0.01; 0.14) for SP, 0.03 (0.00; 0.19) for RP, and 0.02 (0.00; 0.10) for disability. In conclusion, the variability in results obtained by different NRT-certified specialists is reasonable. This suggests that current training standards are appropriate.

Keywords: pain; disability; neuroreflexotherapy; post-marketing surveillance; variability; learning curve (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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