Effectiveness and Cost-Effectiveness of Tuina for Chronic Neck Pain: A Randomized Controlled Trial Comparing Tuina with a No-Intervention Waiting List

Objective: To evaluate whether tuina is more effective and cost-effective in reducing pain compared to no intervention in patients with chronic neck pain. Design: Single-center randomized two-armed controlled trial. Setting: University outpatient clinic specialized in Integrative Medicine. Subjects: Outpatients with chronic neck pain were randomly allocated to tuina or no intervention. Intervention: Six tuina treatments within 3 weeks. Outcome measures: The primary outcome was the mean neck pain intensity during the previous 7 days on a visual analogue scale after 4 weeks (VAS, 0-100 mm, 0 = no pain, 100 = worst imaginable pain). Secondary outcomes included Neck Pain and Disability Scale (NPDS), Neck Disability Index (NDI), health-related quality of life (12-item quality-of-life questionnaire [SF-12]), medication intake, and cost-effectiveness after 4 and 12 weeks. Statistical analysis included analysis of covariance adjusted for baseline values and a full economic analysis from a societal perspective. Results: Altogether, 92 outpatients were included (46 in both groups, 87% female, mean age 45.4 [standard deviation +/- 9.7], and mean VAS 57.7 +/- 11.5). Tuina treatment led to a clinically meaningful reduction in neck pain intensity (group differences, 4 weeks: -22.8 mm [95% confidence interval, -31.7 to -13.8]; p<0.001 and 12 weeks: -17.9 mm [-27.1 to -8.8], p<0.001). No serious adverse events were observed. Total costs as well as quality-adjusted life years (QALYs) did not differ significantly between the groups. When taking group differences into account independently from their statistical significance, costs per QALY gained (incremental cost-effectiveness ratio) would range within a cost-effective area from (sic)7,566 (for costs (sic)10.28 per session) to (sic)39,414 (cost (sic)35 per session). Conclusion: An additional treatment with six tuina sessions over 3 weeks was effective, safe and relatively cost-effective for patients with chronic neck pain. A future trial should compare tuina to other best care options.