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While often not as high in per capita costs as other disabling conditions, sheer prevalence makes back pain and arthritis the most costly conditions requiring rehabilitation in the US, according to a recent study. Authors of the study estimate total combined costs of back pain and arthritis to be over $200 billion per year, exceeding total costs associated with spinal cord injury, traumatic brain injury, stroke, multiple sclerosis, and limb loss.
The study, published in the January 23 issue of the Archives of Physical Medicine and Rehabilitation (abstract only available for free), examined research published between 2008 and 2013 that focused on cost factors—both in terms of direct treatment costs and larger economic/workforce costs—associated with 8 selected conditions: back pain, osteoarthritis, rheumatoid arthritis, limb loss, stroke, spinal cord injury, and traumatic brain injury. Among the 65 articles selected for review, almost all involved national surveys.
The results of analysis showed that back pain and arthritis carried the largest overall price tag, mostly due the reach of the conditions—over 100 million people annually, according to study's authors. "Back pain and arthritis make their impact by sheer numbers in the population," they wrote. "Even if each affected individual misses just a few days of work on average, or has their productivity slightly impaired, the cumulative results across the affected population can amount to tens of billions of dollars in lost wages and reduced work capacity each year."
Findings were different when it came to per capita costs, where authors cited traumatic brain injury as carrying "enormous" costs to the individual. Similarly, stroke—the second-costliest condition in the study—was cited as carrying a high per capita cost, with average cost of ischemic stroke estimated at $140,000 per individual. When necessary, costs in the study were adjusted to 2013 dollars.
Authors cited several limitations in the study, including the lack of recent data that sometimes forced them to rely on older data used as a primary source in the reviewed studies. Additionally, researchers acknowledged the likelihood that comorbidities play a role in overall cost estimates. "While our table does appear to attribute all the cost and disability to a single diagnosis, this may not be the case," they wrote. "Individuals with a stroke may also have an amputation or arthritis, and this may be the source for some of their disability. Thus, there is likely a much more subtle interplay at work that is beyond the scope of this paper."
APTA has a long history of involvement in the development of information and resources on low back pain and osteoarthritis. Some of the resources available to physical therapists (PTs) include a MoveForward webpage on low back pain, the PT's Guide to Osteoarthritis, clinical practice guidelines on low back pain (.pdf) and hip osteoarthritis (.pdf), and a Learning Center presentation on manipulation for low back pain.
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