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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

Author

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  • Ana Royuela

    (CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
    Unidad de Bioestadística, Hospital Puerta de Hierro Majadahonda, IDIPHISA, 28222 Madrid, Spain
    Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 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
    Kovacs Back Pain Unit, HLA-Moncloa University Hospital, 81, Avda, Valladolid, 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
    Institute of Biomedicine (IBIOMED), Campus Universitario, University of León, 24071 León, Spain
    Department of Physiology, University of the Basque Country, 48940 Leioa, Spain)

  • Borja M. Fernández-Félix

    (CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
    Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 Madrid, Spain
    Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, Ctra, de Colmenar Viejo km, 9100, 28034 Madrid, Spain)

  • Víctor Abraira

    (Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 Madrid, Spain
    Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, Ctra, de Colmenar Viejo km, 9100, 28034 Madrid, Spain)

  • Javier Zamora

    (CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
    Spanish Back Pain Research Network, Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Avda, Valladolid, 81, 28008 Madrid, Spain
    Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, Ctra, de Colmenar Viejo km, 9100, 28034 Madrid, Spain)

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.

Suggested Citation

  • Ana Royuela & Francisco M. Kovacs & Jesús Seco-Calvo & Borja M. Fernández-Félix & Víctor Abraira & Javier Zamora, 2021. "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," IJERPH, MDPI, vol. 18(8), pages 1-20, April.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:8:p:3855-:d:531331
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    References listed on IDEAS

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    1. Sophia Rabe-Hesketh & Anders Skrondal, 2012. "Multilevel and Longitudinal Modeling Using Stata, 3rd Edition," Stata Press books, StataCorp LP, edition 3, number mimus2, March.
    2. Corcoll, Josep & Orfila, Jaume & Tobajas, Pablo & Alegre, Luis, 2006. "Implementation of neuroreflexotherapy for subacute and chronic neck and back pain within the Spanish public health system: Audit results after one year," Health Policy, Elsevier, vol. 79(2-3), pages 345-357, December.
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