{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:38:56Z","timestamp":1788287936819,"version":"build-2803163510"},"reference-count":77,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008460","name":"National Center for Complementary and Integrative Health","doi-asserted-by":"publisher","award":["K01AT008965"],"award-info":[{"award-number":["K01AT008965"]}],"id":[{"id":"10.13039\/100008460","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Chiropr Man Therap"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The United States spends more money on the care of back and neck pain than any other health condition. Despite this, the cost-effectiveness for many recommended treatments is unclear. Our primary objective for this project was to estimate the cost-effectiveness of spinal manipulative therapy (SMT), supervised exercise therapy (ET), and home exercise and advice (HEA) for spinal pain in the U.S.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We analyzed cost and clinical outcome data from eight randomized trials conducted in the U.S. using an individual participant data meta-analysis approach. We calculated cost-effectiveness from the societal and healthcare perspective of various comparisons between SMT, ET, and HEA. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life years as the main outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The trials included a total of 1803 participants and 1488 (83%) provided complete data. Incremental cost-effectiveness ratios and probabilities of cost-effectiveness varied substantially between studies; thus, we did not conduct meta-analysis and report findings from individual trials. Cost-effectiveness findings were favorable for SMT compared to HEA for acute neck pain (ICERs below $50k\/QALY) and when added to HEA for chronic back-related leg pain and chronic neck pain in older adults (better outcomes and lower costs). However, SMT was not likely cost-effective compared to HEA for chronic back pain in adults or when added to HEA for older adults (higher costs and worse outcomes). Findings for SMT were favorable when compared to ET in adults with chronic back pain and when added to ET for chronic neck pain in adults (better outcomes and lower costs) and chronic back pain in adolescents (ICERs below $50k\/QALY). However, SMT is not likely cost-effective when compared to ET for chronic neck pain in adults (ICERs below $70k\/QALY for exercise) and findings were inconsistent across outcomes in older adults with chronic back pain. Finally, ET may be cost-effective compared to HEA for adults with chronic neck pain (ICERs largely between $100-$200k\/QALY), but not for chronic back pain or when added to HEA for older adults with chronic neck or back pain (higher costs and worse outcomes).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion<\/jats:title>\n            <jats:p>Cost-effectiveness findings differed between populations based on pain location, duration, and age.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12998-025-00599-8","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T13:18:59Z","timestamp":1755955139000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of spinal manipulation, exercise, and self-management for spinal pain"],"prefix":"10.1186","volume":"33","author":[{"given":"Brent D.","family":"Leininger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M.","family":"Kuntz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Hodges","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roni","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Enns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela Jo","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Bronfort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,23]]},"reference":[{"issue":"11","key":"599_CR1","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1016\/j.jpain.2010.07.002","volume":"11","author":"CB Johannes","year":"2010","unstructured":"Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain. 2010;11(11):1230\u20139.","journal-title":"J Pain"},{"issue":"3","key":"599_CR2","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.pain.2004.11.010","volume":"113","author":"M Von Korff","year":"2005","unstructured":"Von Korff M, Crane P, Lane M, et al. Chronic spinal pain and physical-mental comorbidity in the United States: results from the National comorbidity survey replication. Pain. 2005;113(3):331\u20139.","journal-title":"Pain"},{"issue":"9","key":"599_CR3","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1001\/jama.2020.0734","volume":"323","author":"JL Dieleman","year":"2020","unstructured":"Dieleman JL, Cao J, Chapin A, et al. Us health care spending by payer and health condition, 1996\u20132016. JAMA. 2020;323(9):863\u201384.","journal-title":"JAMA"},{"issue":"24","key":"599_CR4","doi-asserted-by":"publisher","first-page":"2627","DOI":"10.1001\/jama.2016.16885","volume":"316","author":"JL Dieleman","year":"2016","unstructured":"Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996\u20132013. JAMA. 2016;316(24):2627\u201346.","journal-title":"JAMA"},{"issue":"1","key":"599_CR5","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3122\/jabfm.2009.01.080102","volume":"22","author":"RA Deyo","year":"2009","unstructured":"Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22(1):62\u20138.","journal-title":"J Am Board Fam Med"},{"issue":"19","key":"599_CR6","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1097\/BRS.0b013e3182541f45","volume":"37","author":"MA Davis","year":"2012","unstructured":"Davis MA, Onega T, Weeks WB, Lurie JD. Where the united States spends its spine dollars: expenditures on different ambulatory services for the management of back and neck conditions. Spine. 2012;37(19):1693\u2013701.","journal-title":"Spine"},{"issue":"7","key":"599_CR7","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/j.spinee.2011.03.017","volume":"11","author":"JI Ivanova","year":"2011","unstructured":"Ivanova JI, Birnbaum HG, Schiller M, Kantor E, Johnstone BM, Swindle RW. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. Spine J. 2011;11(7):622\u201332.","journal-title":"Spine J"},{"issue":"2","key":"599_CR8","doi-asserted-by":"publisher","first-page":"e2037371","DOI":"10.1001\/jamanetworkopen.2020.37371","volume":"4","author":"JM Stevans","year":"2021","unstructured":"Stevans JM, Delitto A, Khoja SS, et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Netw Open. 2021;4(2):e2037371-2037371.","journal-title":"JAMA Netw Open"},{"key":"599_CR9","doi-asserted-by":"crossref","unstructured":"Weeks WB, Leininger B, Whedon JM et al. The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities. Journal of manipulative and physiological therapeutics. 2016;39(2):63\u201375 e61-62.","DOI":"10.1016\/j.jmpt.2016.01.006"},{"issue":"12","key":"599_CR10","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1097\/MLR.0b013e318269e0b2","volume":"50","author":"BI Martin","year":"2012","unstructured":"Martin BI, Gerkovich MM, Deyo RA, et al. The association of complementary and alternative medicine use and health care expenditures for back and neck problems. Med Care. 2012;50(12):1029\u201336.","journal-title":"Med Care"},{"issue":"2","key":"599_CR11","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s40258-016-0268-8","volume":"15","author":"L Andronis","year":"2017","unstructured":"Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain: a systematic literature review. Appl Health Econ Health Policy. 2017;15(2):173\u2013201.","journal-title":"Appl Health Econ Health Policy"},{"issue":"6","key":"599_CR12","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jmpt.2014.05.001","volume":"37","author":"A Tsertsvadze","year":"2014","unstructured":"Tsertsvadze A, Clar C, Court R, Clarke A, Mistry H, Sutcliffe P. Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials. J Manipulative Physiol Ther. 2014;37(6):343\u201362.","journal-title":"J Manipulative Physiol Ther"},{"key":"599_CR13","doi-asserted-by":"publisher","first-page":"l689","DOI":"10.1136\/bmj.l689","volume":"364","author":"SM Rubinstein","year":"2019","unstructured":"Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689.","journal-title":"BMJ"},{"issue":"5","key":"599_CR14","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.jelekin.2012.02.011","volume":"22","author":"ZA Michaleff","year":"2012","unstructured":"Michaleff ZA, Lin CW, Maher CG, van Tulder MW. Spinal manipulation epidemiology: systematic review of cost effectiveness studies. J Electromyogr Kinesiol. 2012;22(5):655\u201362.","journal-title":"J Electromyogr Kinesiol"},{"key":"599_CR15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c221","volume":"340","author":"RD Riley","year":"2010","unstructured":"Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ. 2010;340: c221.","journal-title":"BMJ"},{"issue":"2","key":"599_CR16","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.jclinepi.2012.04.012","volume":"66","author":"M Brunetti","year":"2013","unstructured":"Brunetti M, Shemilt I, Pregno S, et al. Grade guidelines: 10. considering resource use and rating the quality of economic evidence. J Clin Epidemiol. 2013;66(2):140\u201350.","journal-title":"J Clin Epidemiol"},{"key":"599_CR17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2147","volume":"350","author":"K Loudon","year":"2015","unstructured":"Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The precis-2 tool: designing trials that are fit for purpose. BMJ. 2015;350: h2147.","journal-title":"BMJ"},{"issue":"6","key":"599_CR18","doi-asserted-by":"publisher","first-page":"381","DOI":"10.7326\/M14-0006","volume":"161","author":"G Bronfort","year":"2014","unstructured":"Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014;161(6):381\u201391.","journal-title":"Ann Intern Med"},{"issue":"7","key":"599_CR19","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.spinee.2011.01.036","volume":"11","author":"G Bronfort","year":"2011","unstructured":"Bronfort G, Maiers MJ, Evans RL, et al. Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine J. 2011;11(7):585\u201398.","journal-title":"Spine J"},{"issue":"11","key":"599_CR20","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1097\/BRS.0b013e31823b3bdf","volume":"37","author":"R Evans","year":"2012","unstructured":"Evans R, Bronfort G, Schulz C, et al. Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine. 2012;37(11):903\u201314.","journal-title":"Spine"},{"issue":"7","key":"599_CR21","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1097\/j.pain.0000000000001211","volume":"159","author":"R Evans","year":"2018","unstructured":"Evans R, Haas M, Schulz C, Leininger B, Hanson L, Bronfort G. Spinal manipulation and exercise for low back pain in adolescents: a randomized trial. Pain. 2018;159(7):1297\u2013307.","journal-title":"Pain"},{"issue":"9","key":"599_CR22","doi-asserted-by":"publisher","first-page":"1879","DOI":"10.1016\/j.spinee.2013.10.035","volume":"14","author":"M Maiers","year":"2014","unstructured":"Maiers M, Bronfort G, Evans R, et al. Spinal manipulative therapy and exercise for seniors with chronic neck pain. Spine J. 2014;14(9):1879\u201389.","journal-title":"Spine J"},{"issue":"1","key":"599_CR23","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12998-019-0243-1","volume":"27","author":"C Schulz","year":"2019","unstructured":"Schulz C, Evans R, Maiers M, Schulz K, Leininger B, Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Ther. 2019;27(1):21.","journal-title":"Chiropr Man Ther"},{"issue":"11","key":"599_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7326\/0003-4819-156-1-201201030-00002","volume":"156","author":"G Bronfort","year":"2012","unstructured":"Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(11):1\u201310.","journal-title":"Ann Intern Med"},{"issue":"7","key":"599_CR25","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1097\/00007632-200104010-00020","volume":"26","author":"G Bronfort","year":"2001","unstructured":"Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine. 2001;26(7):788\u201397. discussion 798\u2009\u2013\u2009789.","journal-title":"Spine"},{"key":"599_CR26","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12998-018-0216-9","volume":"26","author":"B Leininger","year":"2018","unstructured":"Leininger B, Bronfort G, Evans R, Hodges J, Kuntz K, Nyman JA. Cost-effectiveness of spinal manipulation, exercise, and self-management for spinal pain using an individual participant data meta-analysis approach: a study protocol. Chiropr Man Ther. 2018;26:46.","journal-title":"Chiropr Man Ther"},{"issue":"7395","key":"599_CR27","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1136\/bmj.326.7395.911","volume":"326","author":"IB Korthals-de Bos","year":"2003","unstructured":"Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ. 2003;326(7395):911.","journal-title":"BMJ"},{"issue":"11","key":"599_CR28","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1093\/rheumatology\/kem245","volume":"46","author":"M Lewis","year":"2007","unstructured":"Lewis M, James M, Stokes E, et al. An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial. Rheumatology (Oxford). 2007;46(11):1701\u20138.","journal-title":"Rheumatology (Oxford)"},{"issue":"18","key":"599_CR29","doi-asserted-by":"publisher","first-page":"E1179","DOI":"10.1097\/BRS.0b013e31820644ed","volume":"36","author":"JE Bosmans","year":"2011","unstructured":"Bosmans JE, Pool JJ, de Vet HC, van Tulder MW, Ostelo RW. Is behavioral graded activity cost-effective in comparison with manual therapy for patients with subacute neck pain? An economic evaluation alongside a randomized clinical trial. Spine. 2011;36(18):E1179\u20131186.","journal-title":"Spine"},{"issue":"49","key":"599_CR30","doi-asserted-by":"publisher","first-page":"iii","DOI":"10.3310\/hta16490","volume":"16","author":"SE Lamb","year":"2012","unstructured":"Lamb SE, Williams MA, Williamson EM, et al. Managing injuries of the neck trial (MINT): a randomised controlled trial of treatments for whiplash injuries. Health Technol Assess. 2012;16(49):iii\u2013iv.","journal-title":"Health Technol Assess"},{"issue":"7479","key":"599_CR31","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1136\/bmj.38282.607859.AE","volume":"329","author":"UBT Team","year":"2004","unstructured":"Team UBT. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ. 2004;329(7479):1381.","journal-title":"BMJ"},{"issue":"3","key":"599_CR32","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1002\/art.22606","volume":"57","author":"DGT Whitehurst","year":"2007","unstructured":"Whitehurst DGT, Lewis M, Yao GL, et al. A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial. Arthritis Rheum. 2007;57(3):466\u201373.","journal-title":"Arthritis Rheum"},{"issue":"12","key":"599_CR33","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1097\/01.brs.0000218486.13659.d5","volume":"31","author":"O Rivero-Arias","year":"2006","unstructured":"Rivero-Arias O, Gray A, Frost H, Lamb SE, Stewart-Brown S. Cost-utility analysis of physiotherapy treatment compared with physiotherapy advice in low back pain. Spine. 2006;31(12):1381\u20137.","journal-title":"Spine"},{"issue":"14","key":"599_CR34","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1097\/BRS.0b013e318067dc26","volume":"32","author":"DJ Critchley","year":"2007","unstructured":"Critchley DJ, Ratcliffe J, Noonan S, Jones RH, Hurley MV. Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation. Spine. 2007;32(14):1474\u201381.","journal-title":"Spine"},{"issue":"6","key":"599_CR35","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1093\/fampra\/cmh612","volume":"21","author":"NH Williams","year":"2004","unstructured":"Williams NH, Edwards RT, Linck P, et al. Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial. Fam Pract. 2004;21(6):643\u201350.","journal-title":"Fam Pract"},{"issue":"7","key":"599_CR36","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1007\/s00586-016-4526-0","volume":"25","author":"JM van Dongen","year":"2016","unstructured":"van Dongen JM, Groeneweg R, Rubinstein SM, et al. Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial. Eur Spine J. 2016;25(7):2087\u201396.","journal-title":"Eur Spine J"},{"issue":"1","key":"599_CR37","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12998-022-00431-7","volume":"30","author":"E Aboagye","year":"2022","unstructured":"Aboagye E, Lilje S, Bengtsson C, Peterson A, Persson U, Skillgate E. Manual therapy versus advice to stay active for nonspecific back and\/or neck pain: a cost-effectiveness analysis. Chiropr Man Therap. 2022;30(1):27.","journal-title":"Chiropr Man Therap"},{"issue":"5","key":"599_CR38","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/BRS.0000000000001729","volume":"42","author":"JM Fritz","year":"2017","unstructured":"Fritz JM, Kim M, Magel JS, Asche CV. Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial. Spine. 2017;42(5):285\u201390.","journal-title":"Spine"},{"issue":"3","key":"599_CR39","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1136\/bjsports-2017-098765","volume":"53","author":"GC Miyamoto","year":"2019","unstructured":"Miyamoto GC, Lin CC, Cabral CMN, van Dongen JM, van Tulder MW. Cost-effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis. Br J Sports Med. 2019;53(3):172\u201381.","journal-title":"Br J Sports Med"},{"key":"599_CR40","doi-asserted-by":"crossref","unstructured":"Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-Effectiveness in health and medicine. Oxford University Press; 2016.","DOI":"10.1093\/acprof:oso\/9780190492939.001.0001"},{"issue":"6","key":"599_CR41","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1177\/0272989X13482524","volume":"33","author":"BM Craig","year":"2013","unstructured":"Craig BM, Pickard AS, Stolk E, Brazier JE. US valuation of the SF-6D. Med Decis Making: Int J Soc Med Decis Mak. 2013;33(6):793\u2013803.","journal-title":"Med Decis Making: Int J Soc Med Decis Mak"},{"issue":"3","key":"599_CR42","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1097\/00005650-200503000-00003","volume":"43","author":"JW Shaw","year":"2005","unstructured":"Shaw JW, Johnson JA, Coons SJ. Us valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care. 2005;43(3):203\u201320.","journal-title":"Med Care"},{"issue":"7","key":"599_CR43","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1007\/s40273-014-0153-y","volume":"32","author":"KA Khan","year":"2014","unstructured":"Khan KA, Petrou S, Rivero-Arias O, Walters SJ, Boyle SE. Mapping EQ-5D utility scores from the PedsQL generic core scales. Pharmacoeconomics. 2014;32(7):693\u2013706.","journal-title":"Pharmacoeconomics"},{"issue":"1\u20132","key":"599_CR44","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.pain.2004.09.012","volume":"113","author":"RH Dworkin","year":"2005","unstructured":"Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1\u20132):9\u201319.","journal-title":"Pain"},{"issue":"6","key":"599_CR45","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jpain.2014.03.005","volume":"15","author":"RA Deyo","year":"2014","unstructured":"Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH task force on research standards for chronic low back pain. J Pain. 2014;15(6):569\u201385.","journal-title":"J Pain"},{"issue":"7","key":"599_CR46","first-page":"409","volume":"14","author":"H Vernon","year":"1991","unstructured":"Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409\u201315.","journal-title":"J Manipulative Physiol Ther"},{"issue":"4","key":"599_CR47","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1002\/art.24399","volume":"61","author":"G van der Velde","year":"2009","unstructured":"van der Velde G, Beaton D, Hogg-Johnston S, Hurwitz E, Tennant A. Rasch analysis provides new insights into the measurement properties of the neck disability index. Arthritis Rheum. 2009;61(4):544\u201351.","journal-title":"Arthritis Rheum"},{"issue":"24","key":"599_CR48","doi-asserted-by":"publisher","first-page":"3115","DOI":"10.1097\/00007632-200012150-00006","volume":"25","author":"M Roland","year":"2000","unstructured":"Roland M, Fairbank J. The roland-morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25(24):3115\u201324.","journal-title":"Spine"},{"key":"599_CR49","unstructured":"Higgins JPT, Thomas J, Chandler J et al. Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 [updated July 2019]. In. The Cochrane Collaboration2019:Available from www.training.cochrane.org\/handbook"},{"issue":"7","key":"599_CR50","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1007\/s40273-013-0056-3","volume":"31","author":"M Krol","year":"2013","unstructured":"Krol M, Brouwer W, Rutten F. Productivity costs in economic evaluations: past, present, future. Pharmacoeconomics. 2013;31(7):537\u201349.","journal-title":"Pharmacoeconomics"},{"issue":"200","key":"599_CR51","first-page":"1","volume":"10","author":"PF Adams","year":"1999","unstructured":"Adams PF, Hendershot GE, Marano MA, Centers for Disease C. Prevention\/National center for health S. Current estimates from the National health interview survey, 1996. Vital Health Stat. 1999;10(200):1\u2013203.","journal-title":"Vital Health Stat"},{"key":"599_CR52","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/1472-6963-7-40","volume":"7","author":"JC Probst","year":"2007","unstructured":"Probst JC, Laditka SB, Wang JY, Johnson AO. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US national household travel survey. BMC Health Serv Res. 2007;7:40.","journal-title":"BMC Health Serv Res"},{"issue":"8","key":"599_CR53","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1002\/hec.1653","volume":"20","author":"B Mihaylova","year":"2011","unstructured":"Mihaylova B, Briggs A, O\u2019Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Econ. 2011;20(8):897\u2013916.","journal-title":"Health Econ"},{"key":"599_CR54","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139506779","volume-title":"Decision making in health and medicine: integrating evidence and values","author":"M Hunink","year":"2014","unstructured":"Hunink M, Weinstein M, Wittenberg E. Decision making in health and medicine: integrating evidence and values. Cambridge: Cambridge University Press; 2014."},{"key":"599_CR55","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1146\/annurev.publhealth.23.100901.140534","volume":"23","author":"AH Briggs","year":"2002","unstructured":"Briggs AH, O\u2019Brien BJ, Blackhouse G. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Annu Rev Public Health. 2002;23:377\u2013401.","journal-title":"Annu Rev Public Health"},{"key":"599_CR56","unstructured":"Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford University Press; 2015."},{"issue":"5","key":"599_CR57","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1002\/hec.903","volume":"13","author":"E Fenwick","year":"2004","unstructured":"Fenwick E, O\u2019Brien BJ, Briggs A. Cost-effectiveness acceptability curves\u2013facts, fallacies and frequently asked questions. Health Econ. 2004;13(5):405\u201315.","journal-title":"Health Econ"},{"issue":"2","key":"599_CR58","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1177\/0272989X06297394","volume":"27","author":"B Groot Koerkamp","year":"2007","unstructured":"Groot Koerkamp B, Hunink MG, Stijnen T, Hammitt JK, Kuntz KM, Weinstein MC. Limitations of acceptability curves for presenting uncertainty in cost-effectiveness analysis. Med Decis Making. 2007;27(2):101\u201311.","journal-title":"Med Decis Making"},{"issue":"12","key":"599_CR59","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1007\/s40273-014-0193-3","volume":"32","author":"R Faria","year":"2014","unstructured":"Faria R, Gomes M, Epstein D, White IR. A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. Pharmacoeconomics. 2014;32(12):1157\u201370.","journal-title":"Pharmacoeconomics"},{"issue":"10","key":"599_CR60","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0046042","volume":"7","author":"GB Stewart","year":"2012","unstructured":"Stewart GB, Altman DG, Askie LM, Duley L, Simmonds MC, Stewart LA. Statistical analysis of individual participant data meta-analyses: a comparison of methods and recommendations for practice. PLoS One. 2012;7(10): e46042.","journal-title":"PLoS One"},{"issue":"12","key":"599_CR61","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1016\/j.jclinepi.2011.03.017","volume":"64","author":"GH Guyatt","year":"2011","unstructured":"Guyatt GH, Oxman AD, Kunz R, et al. Grade guidelines: 7. Rating the quality of evidence\u2013inconsistency. J Clin Epidemiol. 2011;64(12):1294\u2013302.","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"599_CR62","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01536-x","volume":"9","author":"GE Shields","year":"2020","unstructured":"Shields GE, Elvidge J. Challenges in synthesising cost-effectiveness estimates. Syst Rev. 2020;9(1): 289.","journal-title":"Syst Rev"},{"issue":"6","key":"599_CR63","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1080\/14737167.2016.1246960","volume":"16","author":"GA van Mastrigt","year":"2016","unstructured":"van Mastrigt GA, Hiligsmann M, Arts JJ, et al. How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: a five-step approach (part 1\/3). Expert Rev PharmacoEcon Outcomes Res. 2016;16(6):689\u2013704.","journal-title":"Expert Rev PharmacoEcon Outcomes Res"},{"issue":"9","key":"599_CR64","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1056\/NEJMp1405158","volume":"371","author":"PJ Neumann","year":"2014","unstructured":"Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness\u2013the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371(9):796\u20137.","journal-title":"N Engl J Med"},{"key":"599_CR65","first-page":"CD004249","volume":"9","author":"A Gross","year":"2015","unstructured":"Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015;9:CD004249.","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"599_CR66","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.math.2010.04.003","volume":"15","author":"J D\u2019Sylva","year":"2010","unstructured":"D\u2019Sylva J, Miller J, Gross A, et al. Manual therapy with or without physical medicine modalities for neck pain: a systematic review. Man Ther. 2010;15(5):415\u201333.","journal-title":"Man Ther"},{"key":"599_CR67","doi-asserted-by":"crossref","unstructured":"Miller J, Gross A, D\u2019Sylva J et al. Manual therapy and exercise for neck pain: A systematic review. Man Ther 2010. 15(4):334\u201354.","DOI":"10.1016\/j.math.2010.02.007"},{"key":"599_CR68","volume-title":"Noninvasive nonpharmacological treatment for chronic pain: A systematic review update","author":"AC Skelly","year":"2020","unstructured":"Skelly AC, Chou R, Dettori JR, et al. AHRQ comparative effectiveness reviews. Noninvasive nonpharmacological treatment for chronic pain: A systematic review update. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020. Report No.: 20-EHC009."},{"key":"599_CR69","unstructured":"Chou R, Deyo R, Friedly J et al. Noninvasive Treatments for Low Back Pain. Rockville MD2016."},{"issue":"18","key":"599_CR70","doi-asserted-by":"publisher","first-page":"2443","DOI":"10.1001\/jama.290.18.2443","volume":"290","author":"WF Stewart","year":"2003","unstructured":"Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290(18):2443\u201354.","journal-title":"JAMA"},{"issue":"1","key":"599_CR71","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.spinee.2007.10.005","volume":"8","author":"S Dagenais","year":"2008","unstructured":"Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8\u201320.","journal-title":"Spine J"},{"issue":"1","key":"599_CR72","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1377\/hlthaff.2018.05144","volume":"38","author":"GF Anderson","year":"2019","unstructured":"Anderson GF, Hussey P, Petrosyan V. It\u2019s still the prices, stupid: why the US spends so much on health care, and a tribute to Uwe Reinhardt. Health Aff. 2019;38(1):87\u201395.","journal-title":"Health Aff"},{"issue":"8","key":"599_CR73","doi-asserted-by":"publisher","first-page":"E639","DOI":"10.1001\/amajethics.2021.639","volume":"23","author":"DD Kim","year":"2021","unstructured":"Kim DD, Basu A. How does cost-effectiveness analysis inform health care decisions?? AMA J Ethics. 2021;23(8):E639-647.","journal-title":"AMA J Ethics"},{"issue":"5","key":"599_CR74","doi-asserted-by":"publisher","first-page":"e193676","DOI":"10.1001\/jamanetworkopen.2019.3676","volume":"2","author":"LH Kim","year":"2019","unstructured":"Kim LH, Vail D, Azad TD, et al. Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain. JAMA Netw Open. 2019;2(5):e193676.","journal-title":"JAMA Netw Open"},{"issue":"7","key":"599_CR75","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.22062","volume":"5","author":"MC Jin","year":"2022","unstructured":"Jin MC, Jensen M, Zhou Z, et al. Health care resource utilization in management of opioid-naive patients with newly diagnosed neck pain. JAMA Netw Open. 2022;5(7): e2222062.","journal-title":"JAMA Netw Open"},{"issue":"7","key":"599_CR76","doi-asserted-by":"publisher","first-page":"514","DOI":"10.7326\/M16-2367","volume":"166","author":"A Qaseem","year":"2017","unstructured":"Qaseem A, Wilt TJ, McLean RM, Forciea MA. Clinical guidelines committee of the American college of P. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American college of physicians. Ann Intern Med. 2017;166(7):514\u201330.","journal-title":"Ann Intern Med"},{"issue":"2","key":"599_CR77","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1002\/ejp.1679","volume":"25","author":"N Corp","year":"2021","unstructured":"Corp N, Mansell G, Stynes S, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain. 2021;25(2):275\u201395.","journal-title":"Eur J Pain"}],"container-title":["Chiropractic &amp; Manual Therapies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12998-025-00599-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12998-025-00599-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12998-025-00599-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T20:29:27Z","timestamp":1757449767000},"score":1,"resource":{"primary":{"URL":"https:\/\/chiromt.biomedcentral.com\/articles\/10.1186\/s12998-025-00599-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,23]]},"references-count":77,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["599"],"URL":"https:\/\/doi.org\/10.1186\/s12998-025-00599-8","relation":{},"ISSN":["2045-709X"],"issn-type":[{"value":"2045-709X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,23]]},"assertion":[{"value":"23 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research reported in this protocol has been performed in accordance with the Declaration of Helsinki. Ethical approval for the study was provided by the IRB at the University of Minnesota (Study Number 1508E77089). Clinical trial participants provided informed consent prior to their participation in the included trials.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36"}}