Background & Aims

Spinal pain is one of the main causes of years of disability and generates high costs with absenteeism and health services.1 In Brazil, 27 million people over 18 years old suffer from chronic spinal disorders, and the annual healthcare costs with these conditions were $71.4 million.2,3The increase of costs with spinal disorders can be explained by a discrepancy between clinical practice and scientific evidence.4 The concept of value-based healthcare has been implemented with the aim of improving the quality of health services and avoiding waste with non-recommended interventions.5 In order to standardize and guide the evaluation of patients with spinal pain, facilitate clinical decision-making for the best individualized treatment and follow patients over time, SPINEDATA® software was developed. The aim of this study is to analyze the use of the SPINEDATA® software to implement a value-based healthcare model in a health insurance service to the treatment of patients with spinal pain.

Methods

This is a retrospective observational study that used information from a database of a physiotherapy clinic of an insurance health service located in Campinas, Brazil in the period between March 2020 to August 2023. We extracted data from adults aged between 18 and 80 years old with spinal pain. The clinical outcomes were patient satisfaction (Net Promoter Score) after the treatment, and pain (Numerical Pain Scale), function (Oswestry Disability Index), and global perception of improvement (Global Perceived Effect Scale) of patients with spinal pain at baseline, and at six weeks, three, six, and 12 months after the baseline assessment. Data from pregnant women and patients who did not understand Portuguese was not included. We also assessed implementation outcomes, such as acceptability, adoption, suitability, feasibility, and costs. The ANOVA test was used to analyze differences in clinical outcomes between follow-ups. The implementation outcomes were analyzed descriptively.

Results

Data from three hundred and fifteen patients with spinal pain were analyzed in this study. Most patients were female, with chronic low back, and mean age of 49 years old. Most patients were satisfied with health service (NPS=92%). The results for the clinical outcomes showed a statistically significant improvement on pain, function, and global perception of improvement in all follow-ups compared to baseline, respectively. Regarding the implementation outcomes, the use of the SPINEDATA® software to the assess patients before treatment, guide individualized treatment, and follow patients after the treatment seems to present good acceptability, appropriateness and feasibility considering the perspective of patients and physiotherapists. However, missing data in the follow-up assessments was very high (50%). The implementation costs will be presented at the congress if the study is approved.

Conclusions

Considering the results of the study, the use of the SPINEDATA® software seems to facilitate the implementation of the value-based healthcare service model in physiotherapy clinic of an insurance health service, offering individualized treatment recommended by clinical guidelines based on the individual characteristics of patients in the initial assessment (at baseline). Although the SPINEDATA® software can guide the assessment and choose of the best treatment for patients with spinal pain, the follow-up assessments do not seem to be feasible and adjustments to address this issue need to be made.

References

1. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.
2. Instituto Brasileiro de Geografia e Estatística. Coordenação de Trabalho e Rendimento, Brazil. Ministério da Saúde. Pesquisa nacional de saúde 2013.
3. Carregaro RL, da Silva EN, van Tulder M. Direct healthcare costs of spinal disorders in Brazil. Int J Public Health. 2019 Jul 1;64(6):965–74.
4. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83.
5. Porter ME. Value-based health care delivery. Vol. 248, Annals of Surgery. 2008. p. 503–9.

Presenting Author

Ana Emília Soares Castro

Poster Authors

Ana Emilia Castro

PT

Universidade Cidade de São Paulo

Lead Author

Rodrigo Vasconcelos

PhD

Instituto Wilson Mello

Lead Author

Lucíola Costa

PhD

Universidade Cidade de São Paulo

Lead Author

Gisela Cristiane Miyamoto

Universidade Cidade de São Paulo

Lead Author

Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science