Stanford Pilot Study

Pre-trial Pilot Study of the Effect on Patient Reported Outcomes of the Egoscue Method as an Intervention for Spine Pain

Introduction

This white paper reports findings of a pre-trial pilot study conducted by The Clinical Excellence Research Center (CERC) at Stanford University to assess individualized postural therapy (IPT) as delivered by The Egoscue Method (TEM) for spine (back and neck) pain. This pilot study was conducted to inform the design of a subsequent randomized trial of TEM and a second treatment innovation compared to conventional medical treatment. Research on the comparative value of treatment ionization reflects CERC’s mission to discover, demonstrate and help scale innovative, high-value approaches to patient care.

Objective

The pilot study’s purpose was to generate initial estimates of TEM’s impact on patient reported outcomes for pain severity, physical disability, and overall functioning.

Spine Pain

Spine pain is the second most common problem seen in primary care patients. The effectiveness of costly traditional clinical care compared to no treatment is negligible for many patients. Frequent use of imaging technologies, pain medications, and surgeries contribute to growing costs of care of this condition. In 2005, the national expenditure for back and neck pain (spine pain) approached $86 billion, a 60% increase over 1995.1 Patients with spine pain in 2005 report worse physical and social function, mental health, and ability to work than patients did a decade prior.1 Over the same time period, the prevalence of disability attributed to musculoskeletal pain— of which back pain contributed a large portion — rose from 20% to 25% in the US adult population. In brief, over the last few decades, the United States is spending more and experiencing worse outcomes for care of spine pain.

The Egoscue Method: CERC’s review of the research literature and interviews with experts in spine pain care indicated that exercise regimens based on postural therapy such as TEM can achieve improved patient outcomes without the expense and risks of imaging, prescription pain medications, referrals to orthopedic specialists, and surgeries. The Egoscue Method is a non-medical treatment in which a TEM-trained therapist evaluates a subject’s posture to identify postural and alignment deviations. Based on these findings the therapist develops a personalized corrective exercise program for patients. Patients are instructed on how to perform the exercises correctly and given updated exercise regimens in successive visits. Patients are asked to perform recommended exercises daily. A standard course of TEM care for spine pain involves six to eight clinic visits. Spine Pain Intervention to Enhance Care quality And Reduce Expenditure (SPINECARE): CERC is conducting a multi-center national pragmatic randomized clinical trial that compares two approaches to treating acute or acute on chronic spine pain to usual care. One of these approaches is The Egoscue Method. Each of the two experimental arms will be compared to usual care individually. The results of this study will be forthcoming.

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Pilot Methods

Patient Survey: CERC compiled a patient survey by drawing on well-validated surveys measuring fourkey outcomes: level of pain; disability level related to spine pain; health status; and self-efficacy (Table1). The survey also collected data on demographics, previous care received for spine pain, and patientconfidence in their ability to manage subsequent episodes of spine pain (Appendix).Table 1. Description of Surveys Used to Measure Key Outcomes

Patient Recruitment

Patients attending three Egoscue clinics in San Francisco, Phoenix, and San Diego were invited to participate in the study. Inclusion criteria included a chief complaint of spine pain, having had no more than one Egoscue visit for their current episode of spine pain, and being over 18 years of age. Patients meeting these criteria who agreed to participate in the study and signed an informed consent were given the baseline Egoscue patient survey. A second follow-up survey was administered eight weeks later. Both surveys were paper based and self-administered.

Study Population

Nineteen patients were enrolled in the study, with 11 women and 8 men. Patients had an average age of 54 and all but one was college educated. More than half of the patients had other comorbidities such as diabetes (5), lung disease (6), and kidney disease (4). They reported having either back (11) or both back and neck pain (7). Duration of the current episode ranged from several months (9) to more than five years (2).

Findings

Patients reported (as defined in Table 1) improvement on all four outcome measures: pain level, disability, health status and self-efficacy (See Table 2). The strongest positive change was reported in pain level where average scores moved from 7.3 to 4.3 on a scale from 0-10 with lower scores meaning lower perceived pain. This change equated to a 41% decrease in pain severity. In the measure of disability due to spine pain, patients’ scores changed from 30.1 to 11.5 on the 100-point scale where higher scores mean more disability. This equated to a 62% improvement. On health status, patients showed meaningful improvement with an 18.8% increase in quality of life. For self-efficacy, scores indicated a 9.6% increase in ability to manage pain. Additionally, illustrative patient comments are listed in Table 3

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