Is more better when it comes to musculoskeletal care?

A recent study set out to determine whether more visits and higher costs of musculoskeletal care improves patient outcomes.

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STUDY: Do the number of visits and the cost of musculoskeletal care improve outcomes? More may not be better – Clewley et al (2020)

Study reviewed by Todd Hargrove in the December 2020 issue of the Research Reviews

Key points from the study:

• The amount of health care use for treatment of shoulder pain was not associated with changes in pain and disability.
• High and low responders to treatment of shoulder pain spent similar amounts of money on treatment and had a similar number of health care visits.

Okay, let’s dive into it!

Background and Objective:

This study analyzed data from an RCT related to different treatments for subacromial pain syndrome (SAPS) to determine whether the number of visits and cost of treatment were associated with patient-reported changes in pain and disability.

Methods:

The RCT included 104 patients who received either a corticosteroid injection or manual therapy plus exercise. The authors divided the patients into high and low responders, based on 1-year change in Shoulder Pain and Disability Index (SPADI) scores. Regression analysis was used to determine the association between changes in SPADI and health care use.

Results:

The high responder group had an average SPADI change of 48.83, while the low responder group had an average change of 8.21. There was no significant difference in the number of visits and costs between the high and low responder groups.

Limitations:

• The analysis combined patients who received different treatments, and there may be different patterns of health care use for these treatments.
• Patients may seek care differently when they are in a formal study.

Clinical Implications:

Value-based health care is an attempt to measure the value of care by comparing the amount of money spent to actual changes in health. It has been shown in many contexts that more health care does not necessarily lead to better outcomes.

In this study, the authors concluded that more health care related to treatment of SAPS was not associated with better outcomes. However, this finding pertains to a specific group of people receiving a specific kind of treatment, and so the results may not be generalizable to other treatment methods for shoulder pain or other patient populations/conditions.

Furthermore, it may be that certain individuals benefit from more visits than others, even when there is no benefit on average for a large group.The authors point out that there may also be a “plateau” above which there is no additional benefit from more visits.

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