Cost effectiveness of manipulation for spine pain using individual patient data

使用个体患者数据治疗脊柱疼痛的成本效益

• 批准号: 9012413
• 负责人: Brent Leininger
• 金额: $ 11.19万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9012413
• 关键词: Accounting; Address; Adult; Affect; Back Pain; Caring; Characteristics; Chiropractor; Clinical; Clinical Research; Clinical Sciences; Clinical Services; Clinical Trials; Clinical effectiveness; Collaborations; Communication; Complementary therapies; Complex; Cost Analysis; Cost Effectiveness Analysis; Cost effectiveness research; Country; Data; Data Analyses; Development; Development Plans; Diabetes Mellitus; Educational workshop; Environment; Epidemiology; Exercise Therapy; Expenditure; Faculty; Fellowship; Funding; Future; Goals; Gold; Grant; Healed; Health; Health Services Research; Healthcare; Healthcare Systems; Heart Diseases; Individual; Individual National Research Service Award; Institutes; Integrative Medicine; Intervention; Interview; Knowledge; Malignant Neoplasms; Manuals; Medical; Medicine; Mentors; Mentorship; Meta-Analysis; Metadata; Methods; Mind-Body Intervention; Minnesota; Modeling; Neck Pain; Outcome; Pain management; Participant; Population; Provider; Public Health; Public Health Nurses; Public Health Nursing; Publishing; Quality-Adjusted Life Years; Randomized Clinical Trials; Research; Research Methodology; Research Personnel; Research Project Grants; Resources; Review Literature; Risk; Sampling; Schools; Scientist; Self Management; Spinal; Spinal Manipulation; Spine pain; Spirituality; Surveys; Time; Training; Training Activity; Translational Research; Translations; United States; United States National Institutes of Health; Universities; Update; Vertebral column; Work; Writing; base; career; career development; career networking; chiropracty; chronic pain; cost; cost effective; cost effectiveness; data management; design; economic evaluation; economic outcome; education research; experience; healing; health care service utilization; health economics; improved; individual patient; innovation; meetings; novel; osteopath; physical therapist; public health relevance; research and development; responsible research conduct; skills; social; symptom management; systematic review; trial comparing

 DESCRIPTION (provided by applicant): Background: Spine pain is a persistent and disabling condition responsible for a large proportion of chronic pain in the U.S. Conventional management strategies for spine pain are costly, largely ineffective, and at times harmful. There is evidence suggesting complementary and integrative health interventions, such as spinal manipulation, can reduce the clinical and cost burden of spinal pain; however, the quality of current evidence is limited and there are concerns regarding generalizability to the U.S. spine pain population. Goals & Objectives: Dr. Leininger's long-term career objective is to become an independent research scientist focused on conducting rigorous and relevant research investigating the clinical and cost-effectiveness of complementary and integrative health interventions for spinal pain conditions. Two and half years ago, Dr. Leininger received a Ruth L. Kirschstein National Research Service Award Individual Postdoctoral Fellowship (F32) to train in clinical research and gain an introduction to cost-effectiveness analysis. The overall objective of the proposed K01 application is to provide Dr. Leininger protected time to gain advanced skills and experience in clinical and health services research necessary for reaching his long-term career objective. The proposed career development plan will enable Dr. Leininger to achieve his short and intermediate-term goals of gaining additional knowledge, training and experience in advanced statistical analyses; health services research methods; cost-effectiveness analyses using individual patient data; data analyses using large national surveys; systematic review methods for clinical and health economic outcomes; and scientific writing and communication. Career Development/Training Activities: The K01 application will build on Dr. Leininger's training as a chiropractor, as well his research education and development as part of his F32. With his mentors, Dr. Leininger has crafted a comprehensive career plan appropriate for his level of development and consistent with his long term career objectives. The plan will engage Dr. Leininger in robust training activities including: 1) mentorship; 2) coursework; 3) a research project; 4) publishing and presenting; 5) workshops and seminars; 6) grant-writing; and 7) responsible conduct of research. Mentors: Dr. Leininger's mentorship team consists of accomplished scientists from clinical research, health services research and social epidemiology fields with a diverse range of expertise in topics relevant to his research project and his career goals. His mentors have expertise in randomized clinical trials, systematic reviews, hierarchical statistical analyses, trial based cost-effectiveness analyses, modeling methods for economic evaluations, large complex survey data management and analyses, and under-represented populations. In addition to providing Dr. Leininger scientific guidance, his mentors will also offer career advice and facilitate new research collaborations which will allow him to broaden his professional network. Environment: Dr. Leininger will benefit from a wealth of resources available to aspiring researchers at the University of Minnesota (UMN), which is ranked in the top 9 of all public universities in the United States. Based in the innovative Center for Spirituality & Healing, a university-wide center within the UMN's Academic Health Center, Dr. Leininger will be well situated to continue to develop meaningful collaborative and interdisciplinary relationships with faculty from the Schools of Public Health, Nursing and Medicine. He will also capitalize on intellectual, facility and funding resources available from th Clinical and Translational Science Institute (the UMN's NIH funded CTSA). Research: Dr. Leininger's proposed K01 research project will address the significant and costly issue of spinal pain management within the United States. Dr. Leininger will determine the cost-effectiveness of spinal manipulation for spine pain conditions by combining existing data from eight pragmatic randomized clinical trials conducted in the U.S. by his primary mentor, with comparable interventions and outcomes using a novel individual patient data meta-analysis approach (Specific Aim 1). The project will address significant gaps in our current understanding of the cost-effectiveness of spinal manipulation within the U.S. healthcare system. Dr. Leininger will also address a commonly cited limitation of trial based cost-effectiveness analyses by determining the generalizability of clinical trial participants in relation to the U.S. spine pain population (Specific Aim 2). Finally, Dr. Leininger will update existing systematic reviews with the results of these important U.S. based analyses using rigorous and contemporary systematic review methods for determining risk of bias and the overall evidence (Specific Aim 3).

 描述（由申请人提供）：背景：脊柱疼痛是一种持续性致残性疾病，在美国造成很大一部分慢性疼痛。传统的脊柱疼痛治疗策略成本高昂，基本上无效，有时甚至有害。有证据表明，补充疗法是有害的。脊柱推拿等综合健康干预措施可以减轻脊柱疼痛的临床和费用负担；然而，目前证据的质量有限，并且人们担心其对美国脊柱疼痛人群的普遍性。目标：Leininger 博士的长期职业目标是成为一名独立研究科学家，专注于开展严格且相关的研究，调查针对脊柱疼痛状况的补充和综合健康干预措施的临床和成本效益。 Leininger 获得了 Ruth L. Kirschstein 国家研究服务奖个人博士后奖学金 (F32)，以接受临床研究培训并了解成本效益分析。拟议的 K01 申请的总体目标是为 Leininger 博士提供资助。拟议的职业发展计划将使莱宁格博士能够实现获得额外知识、培训和发展的短期和中期目标。先进的统计分析经验；使用个体患者数据的成本效益分析；使用大型全国性调查的数据分析；以及科学写作和培训活动。 K01 应用程序将基于 Dr.作为脊椎按摩师的培训，以及作为 F32 的一部分的研究教育和发展，Leininger 博士与他的导师一起制定了适合他的发展水平并符合他的长期职业目标的全面职业计划。让莱宁格博士参与强有力的培训活动，包括：1）指导；3）研究项目；5）研讨会和研讨会； 7) 负责任的导师：莱宁格博士的导师团队由来自临床研究、卫生服务研究和社会流行病学领域的杰出科学家组成，他们在与他的研究项目和导师希斯的职业目标相关的主题上拥有广泛的专业知识。随机临床试验、系统评价、分层统计分析、基于试验的成本效益分析、经济评估建模方法、大型复杂调查数据管理和分析以及代表性不足的人群方面的专业知识除了提供莱宁格博士的科学指导外，他的导师还将提供职业建议并促进新的研究合作，这将使他能够扩大自己的专业网络环境：Leininger 博士将受益于明尼苏达大学 (UMN) 为有抱负的研究人员提供的丰富资源，该大学在世界排名中名列前茅。美国所有公立大学中排名前 9 的大学，位于创新中心。 灵性与治疗是UMN学术健康中心内的全校范围的中心，Leininger博士将处于有利位置，能够继续与公共卫生学院、护理学院和医学院的教师建立有意义的合作和跨学科关系。临床和转化科学研究所（UMN 的 NIH 资助的 CTSA 研究）提供的智力、设施和资金资源：Leininger 博士提出的 K01 研究项目将解决重大且成本高昂的脊柱问题。 Leininger 博士将通过结合他的主要导师在美国进行的八项实用随机临床试验的现有数据，以及使用新颖的方法进行的可比较的干预措施和结果，确定脊柱推拿治疗脊柱疼痛的成本效益。个体患者数据荟萃分析方法（具体目标 1）将解决我们目前对美国医疗保健系统中脊柱操纵的成本效益的理解中的重大差距，莱宁格博士还将解决基于试验的常见局限性。通过确定与美国脊柱疼痛人群相关的临床试验参与者的普遍性来进行成本效益分析（具体目标 2）。最后，Leininger 博士将使用这些重要的美国分析结果，使用严格的当代系统性分析的结果来更新现有的系统评价。审查确定偏倚风险和总体证据的方法（具体目标 3）。