Analysis of the clinical effectiveness and cost-effectiveness of community-based rehabilitation therapy for chronic musculoskeletal pain
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摘要:
目的 基于基层康复服务实施规范不足致使利用率偏低的现实背景，本研究聚焦社区居民常见的慢性肌肉骨骼疼痛疾病，提炼基层医疗机构场景下的高频康复治疗技术类别，并分析其临床有效性与经济性，探索当前基层康复服务中的关键问题，为优化基层康复服务提供科学依据。 方法 经纳排标准筛选，本研究共纳入2024年1月1日—7月30日于上海市6家社区卫生服务中心就诊的慢性肌肉骨骼疼痛患者303例。依据康复技术类型，分为中医康复治疗组、西医康复治疗组和中西医结合康复治疗组三大类别，每类含受试对象101例。通过综合评价患者的疼痛程度及关节功能改善情况，比较西医、中医及中西医结合三组类别内高频利用的各康复技术的临床疗效；同时，统计患者医疗费用，评价各技术的成本效果比。 结果 在西医的具体治疗类别中，物理因子治疗总有效率最高，为93.48%（43/46），且经济性最佳（CER=4.27），显著优于运动疗法联合手法治疗组（总有效率82.35%，14/17；CER=11.54）。在中医的具体类别中，单一推拿治疗总有效率（96.97%，32/33）与推拿+针灸+拔罐组相近（94.74%，18/19），但费用显著更低（360元vs. 710元），更具有经济学价值（CER：3.71 vs. 7.49）。 结论 针对慢性肌肉骨骼疼痛患者，物理因子治疗和推拿治疗的有效率较高且具有经济性，但服务过程中存在供给效能不足、标准化服务范本缺失、服务质量参差等问题。 Abstract:Objective This study focuses on chronic musculoskeletal pain conditions, with the ultimate goal of identifying frequently applied rehabilitation techniques in primary care settings and analyzing their clinical effectiveness and cost-effectiveness, thereby exploring key issues in current service delivery and providing a scientific basis for optimization. Methods A total of 303 patients with chronic musculoskeletal pain were enrolled from six community health centers in Shanghai, between January 1 and July 30 2024, following screening against the eligibility criteria. Based on the type of rehabilitation technique received, patients were divided into three groups: western rehabilitation (n=101), traditional Chinese medicine (TCM) rehabilitation (n=101), and integrated Chinese-western rehabilitation (n=101). Clinical efficacy was evaluated by comprehensively assessing improvements in pain intensity and joint function, comparing high-frequency techniques within each group. Meanwhile, we calculated patient medical costs and assessed the cost-effectiveness ratio (CER) for each technique. Results Among western rehabilitation techniques, physiotherapy demonstrated the highest overall effectiveness (93.48%, 43/46) and best cost-effectiveness (CER=4.27), significantly outperforming the combination of exercise therapy and manual therapy (Overall Efficiency Rate: 82.35%, 14/17; CER= 11.54). Among TCM techniques, the single-modality massage therapy demonstrated similar clinical efficacy (96.97%, 32/33) to the combined massage, acupuncture and cupping therapy group (94.74%, 18/19). However, its cost was significantly lower (360 RMB vs. 710 RMB), resulting in greater economic value (CER: 3.71 vs. 7.49). Conclusion For patients with chronic musculoskeletal pain, both physiotherapy and massage treatment demonstrate high efficacy and cost-effectiveness. However, challenges such as insufficient service efficiency, lack of standardized protocols and variability in service quality persist during implementation. -
Key words:
- Musculoskeletal pain /
- Rehabilitation /
- Community health centers /
- Effectiveness /
- Cost-effectiveness
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表 1 不同西医康复技术组别慢性肌肉骨骼疼痛患者的频数及占比分布
Table 1. The frequency and proportion distribution of patients with chronic musculoskeletal pain in different groups of Western medicine rehabilitation techniques
疗法类别 例(%) 物理因子治疗 46(45.54) 物理因子+运动疗法+手法治疗 21(20.79) 运动疗法+手法治疗 17(16.83) 物理因子+牵引治疗 9(8.91) 其他 8(7.92) 
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表 2 不同高频西医康复技术类别慢性肌肉骨骼疼痛患者临床疗效比较[例(%)]
Table 2. Comparison of clinical efficacy of different high-frequency Western medicine rehabilitation techniques in patients with chronic musculoskeletal pain[cases(%)]
疗法类别 例数 无效 好转 显效 总有效 H值 P值 物理因子治疗 46 3(6.52) 7(15.22) 36(78.26) 43(93.48) 运动疗法+手法治疗 17 3(17.65) 7(41.18) 7(41.18) 14(82.35) 8.587 0.016 物理因子+运动疗法+手法治疗 21 2(9.52) 8(38.10) 11(52.38) 19(90.48)
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表 3 不同高频西医康复技术类别慢性肌肉骨骼疼痛患者成本效果比较
Table 3. Comparison of cost-effectiveness among different high-frequency Western medicine rehabilitation techniques for patients with chronic musculoskeletal pain
疗法类别 成本(C，元) 治疗有效率(E，%) C/E 物理因子治疗 400 93.48 4.27 运动疗法+手法治疗 950a 82.35 11.54 物理因子+运动疗法+手法治疗 1 000a 90.48 11.05 注：与物理因子治疗组比较，aP < 0.025；成本数据以中位数描述。
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表 4 不同中医康复技术组别慢性肌肉骨骼疼痛患者的频数及占比分布
Table 4. Distribution of frequency and proportion of patients in different groups of traditional Chinese medicine rehabilitation techniques
疗法类别 例(%) 推拿治疗 33(32.67) 拔罐+针灸+推拿治疗 19(18.81) 拔罐+针灸治疗 16(15.84) 中医外治法+针灸治疗 10(9.90) 其他 23(22.77)
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表 5 高频中医康复技术类别慢性肌肉骨骼疼痛患者临床疗效比较[例(%)]
Table 5. Comparison of the clinical efficacy of major traditional Chinese medicine rehabilitation techniques[cases(%)]
疗法类别 例数 无效 好转 显效 总有效 H值 P值 推拿治疗 33 1(3.03) 14(42.42) 18(54.55) 32(96.97) 拔罐+针灸治疗 16 3(18.75) 2(12.50) 11(68.75) 13(81.25) 1.420 0.492 拔罐+针灸+推拿治疗 19 1(5.26) 4(21.05) 14(73.68) 18(94.74)
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表 6 高频中医康复技术类别慢性肌肉骨骼疼痛患者成本效果比较
Table 6. Cost-effectiveness comparison of major traditional Chinese medicine rehabilitation techniques
疗法类别 成本(C，元) 治疗有效率(E，%) C/E 推拿治疗 360 96.97 3.71 拔罐+针灸治疗 590a 81.25 7.26 拔罐+针灸+推拿治疗 710a 94.74 7.49 注：与推拿治疗组比较，aP < 0.025；成本数据以中位数描述。
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表 7 不同中西医结合康复技术组别慢性肌肉骨骼疼痛患者的频数及占比分布
Table 7. Distribution of frequency and proportion of patients in different groups of integrated traditional Chinese and western rehabilitation techniques
疗法类别 例(%) 物理因子+中医定向透药 41(40.59) 物理因子+针灸+拔罐治疗 24(23.76) 物理因子+针灸治疗 17(16.83) 物理因子+推拿治疗 7(6.93) 其他 12(11.88)
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表 8 高频中西医结合康复技术类别慢性肌肉骨骼疼痛患者临床疗效比较[例(%)]
Table 8. Comparison of the clinical efficacy of major integrated traditional Chinese and western rehabilitation techniques[cases(%)]
疗法类别 例数 无效 好转 显效 总有效 H值 P值 物理因子+中医定向透药 41 1(2.44) 2(4.88) 38(92.68) 40(97.56) 物理因子+针灸治疗 17 1(5.88) 6(35.29) 10(58.82) 16(94.12) 12.300 0.002 物理因子+针灸+拔罐治疗 24 2(8.33) 8(33.33) 14(58.33) 22(91.67)
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表 9 高频中西医结合康复技术慢性肌肉骨骼疼痛患者成本效果比较
Table 9. Cost-effectiveness comparison of major integrated traditional Chinese and western rehabilitation techniques
疗法类别 成本(C，元) 治疗有效率(E，%) C/E △C/△E 物理因子+中医定向透药 770 97.56 7.89 17.44 物理因子+针灸治疗a 710 94.12 7.54 - 物理因子+针灸+拔罐治疗 945 91.67 10.31 - 注：成本数据以中位数描述。a为参照组；△C/△E(增量成本效果比)为各方案与参照组比较的结果，参照组自身及效果低于参照组的方案，其△C/△E无意义，以“-”表示。
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