JMIR Publications

ABSTRACT

Background:

Adult scoliosis (AS) is a prevalent condition estimated at 38%. Symptomatic AS is associated with substantial healthcare costs. The role of nonoperative interventions in the management of AS remains elusive. The National Scoliosis Clinic’s (NSC) Scoliosis Realignment Therapy (SRT) is a personalized digital health exercise program for the nonoperative management of AS.

Objective:

The purpose of this study was two-fold: (1) To evaluate the effect of the SRT program on users’ intention of having spinal fusion; and (2) From a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery.

Methods:

Individuals were enrolled in the SRT study from October 1, 2023 to September 1, 2024. Participants were surveyed about history of prior scoliosis surgery and intent of having surgery before and after use of SRT (on a 4-point Likert scale, where 1 = “No Intent for Surgery” and 4 = “High Intent for Surgery”). Intent for surgery before and after participation in SRT was compared using a paired t-test. Annual cost savings per 100,000 beneficiaries by averting spinal fusions were estimated separately for commercial payers and Medicare using published literature and public data sources. Payer expenditures were inflation-adjusted to 2024 US dollars using the Hospital Services component of the Consumer Price Index.

Results:

In total, 62 NSC members were enrolled in the SRT study for an average of 17 weeks (SD 12). The mean age was 65.3 (SD 13.5) years and the majority were female (98%) and white (98%). Among the SRT users who did not have prior scoliosis surgery (N=56), 14% (8/56) reported a decrease in intent for surgery (that is, a lower Likert score) with use of SRT. The mean intent for surgery scores before compared to after SRT were 1.29 (SD 0.53) and 1.14 (SD 0.35), respectively (mean difference 0.15 [P=.004, Cohen d=0.32]). Participants with “No Intent for Surgery” pre- versus post-use of SRT (42/56 versus 48/56, respectively) corresponds to an absolute risk reduction (ARR) of 11% and a number needed to treat (NNT) of 9 to avert one spinal fusion. Among the six participants who transitioned to “No Intent” for spinal surgery with use of SRT, three were <65 and three were ≥65 years of age. Annual cost savings from averted spinal surgeries were estimated at US $415,000 per 100,000 commercially-insured beneficiaries and US $617,000 per 100,000 Medicare beneficiaries.

Conclusions:

SRT is a personalized, scoliosis-specific digital health exercise program with the potential for averting 1 spinal surgery for every 9 participants, resulting in a substantial reduction in payer expenditures while improving quality of care for commercial payer and Medicare beneficiaries.