Aspects of musculoskeletal pain interfering with normal life and naprapathic manual therapy from a health technology assessment perspective

Sammanfattning: IntroductionMusculoskeletal pain is one of the most common reasons for seeking health care. If a patient’s disorders remain after conventional primary care, a referral to secondary care is often made, yet many referrals on the waiting lists concern patients who are not in need of surgery. Manual therapy has a lot of “proved experience” but is not routine in the Swedish national health care system today. There is a lack of scientific evidence for its treatment and cost effects.AimsThe overall aim of this thesis was to increase the knowledge of musculoskeletal pain that interferes with normal life. Specific aims were to investigate if musculoskeletal pain in older adults is associated with heavy physical and negative psychosocial workloads through life, and to deepen the knowledge of the treatment and cost effects of naprapathic manual therapy (NMT), and of older adults' experiences of reminders of home exercises through mHealth.MethodsStudy I is a cross sectional study (n=641) that investigates associations between musculoskeletal pain interfering with normal life in older adults and physical and psychological loads through life. Study II is a randomised controlled trial (n=78) that compares NMT with standard orthopaedic care for “low priority” orthopaedic outpatients. Study III (n=1) is a case study that describes the treatment effects of NMT in a patient diagnosed with adhesive capsulitis. Study IV is a cost consequence analysis (n=78), where the costs and the health economic gains in study II were analyzed. Study V is a qualitative interview study (n=8) exploring older adults’ experiences of text messages as reminders of home exercises after NMT.Results The results in Study I were that psychosocial and physical workloads are associated with musculoskeletal pain that interferes with normal life in older adults. NMT for low priority orthopaedic outpatients yielded larger improvements in pain, physical function and perceived recovery compared with standard orthopaedic care (Study II). NMT for the acromio-clavicular joint, for adhesive capsulitis resulted in significant pain relief and perceived recovery, decreased sleeping disorders and medication (Study III). The health gains for naprapathy were higher compared with standard orthopaedic care, and the costs significantly lower (Study IV). Study V concluded that the use of SMS:s as reminders of home exercises after NMT were appreciated by the patients, and stimulated them to practice memorising and to create.Conclusion This thesis suggests that pain in older adults is associated with heavy physical and negative psychosocial workloads through life. NMT may be cost effective for low priority orthopaedic outpatients of working age with musculoskeletal disorders that are not likely to benefit from orthopaedic surgery, and was effective in a patient diagnosed with adhesive capsulitis. mHealth used to remind older adults of home exercises stimulates the patients to create own routines for continued compliance.