Gerald F. Kominski

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OBJECTIVES This study compared the relative effectiveness of cervical spine manipulation and mobilization for neck pain. METHODS Neck-pain patients were randomized to the following conditions: manipulation with or without heat, manipulation with or without electrical muscle stimulation, mobilization with or without heat, and mobilization with or without(More)
STUDY DESIGN Randomized clinical trial. OBJECTIVES To compare the long-term effectiveness of medical and chiropractic care for low back pain in managed care and to assess the effectiveness of physical therapy and modalities among patients receiving medical or chiropractic care. SUMMARY OF BACKGROUND DATA Evidence comparing the long-term relative(More)
STUDY DESIGN A randomized clinical trial. OBJECTIVES To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. SUMMARY OF BACKGROUND DATA Despite the(More)
BACKGROUND The purpose of this study was to compare the cost-effectiveness of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty in patients with degenerative arthritis limited to either the medial or lateral compartment. METHODS A decision model was created for the treatment of end-stage unicompartmental knee arthritis. A(More)
OBJECTIVE We sought to compare total outpatient costs of 4 common treatments for low-back pain (LBP) at 18-months follow-up. METHODS Our work reports on findings from a randomized controlled trial within a large medical group practice treating HMO patients. Patients (n = 681) were assigned to 1 of 4 treatment groups, ie, medical care only (MD), medical(More)
BACKGROUND There is renewed interest in total ankle arthroplasty as an alternative to ankle fusion in the treatment of end-stage ankle arthritis. Despite a lack of long-term data on the clinical outcomes associated with these implants, the use of ankle arthroplasty is expanding. The purpose of this cost-effectiveness analysis was to evaluate whether the(More)
OBJECTIVE This study was designed to assess the burden of disease and injury in the Los Angeles County population using Disability-Adjusted Life Years (DALYs), a composite measure of premature mortality and disability that equates to years of healthy life lost. METHODS DALYs, stratified by gender and race/ethnicity, were calculated for 105 health(More)
The Medical Services Initiative program--a safety net-based system of care--in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a(More)
BACKGROUND The influence of payment mechanisms on physician decisions is not well understood. OBJECTIVES The objective of this study was to test 2 null hypotheses: 1) physicians' clinical decisions would not be influenced by payment incentives; and 2) physicians would have equal concern about medical decisions made under capitation or fee-for-service(More)
BACKGROUND Although chiropractors often use physical modalities with spinal manipulation, evidence that modalities yield additional benefits over spinal manipulation alone is lacking. OBJECTIVE The purpose of the study was to estimate the net effect of physical modalities on low back pain (LBP) outcomes among chiropractic patients in a managed-care(More)