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Ma J, Guo G, Yue H, Xie C, Xie F, Chen Z, Gu Y, Zhang S, Fang M, Yao F. Tuina on knee pain and functional decline of lower limbs for patients with mild-to-moderate knee osteoarthritis in Shanghai: protocol for a multicentre, assessor-blinded, randomised controlled trial. BMJ Open 2024; 14:e083440. [PMID: 38866576 PMCID: PMC11177681 DOI: 10.1136/bmjopen-2023-083440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is one of the most common osteoarthritis, imposing substantial economic and medical burdens on both individuals and society. In China, Tuina has been selected as a complementary and alternative therapy to relieve knee pain and dysfunction symptoms. However, the current evidence is insufficient to support the efficacy of Tuina therapy in addressing knee pain and improving physical function. The trial aims to compare the effectiveness of Tuina with celecoxib, which is considered as the standard treatment, and to assess its potential as an alternative therapy through changes in outcome measures. METHODS AND ANALYSIS A total of 360 KOA patients aged between 40 and 70 years and classified as Kellgren and Lawrence grades I-II will be recruited from eight subcentral hospitals. The participants will be randomly assigned to either the treatment group (Tuina, Biw) or the control group (celecoxib, Qd), with both groups undergoing a 4-week intervention phase followed by an 8-week follow-up phase. The primary outcome is the change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at week 4 compared with baseline. Secondary outcomes including WOMAC stiffness and function subscales, WOMAC total score, 36-item Short-Form Health Survey, Timed Up and Go test, Short Physical Performance Battery, gait analysis parameters and pain medication records will be assessed at weeks 4, 8 and 12. Any adverse events that occur during the trial will be promptly recorded. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2023SHL-KY-16-01, 2023SHL-KY-16-02). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2300069416.
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Affiliation(s)
- Jianwen Ma
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangxin Guo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Chaoqun Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziying Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanjia Gu
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuaipan Zhang
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Silvernail JL, Deyle GD, Jensen GM, Chaconas E, Cleland J, Cook C, Courtney CA, Fritz J, Mintken P, Lonnemann E. Orthopaedic Manual Physical Therapy: A Modern Definition and Description. Phys Ther 2024; 104:pzae036. [PMID: 38457654 DOI: 10.1093/ptj/pzae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/04/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.
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Affiliation(s)
| | - Gail D Deyle
- Graduate School, Baylor University, San Antonio, Texas, USA
| | - Gail M Jensen
- Graduate School and College of Professional Studies, Creighton University, Omaha, Nebraska, USA
| | - Eric Chaconas
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Josh Cleland
- Department of Rehabilitation Science, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Chad Cook
- Division of Physical Therapy, Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Carol A Courtney
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Julie Fritz
- Orthopaedic Surgery, Orthopaedic Surgery Operations, Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Paul Mintken
- Department of Physical Therapy, Hawai'i Pacific University, Honolulu, Hawaii, USA
| | - Elaine Lonnemann
- Physical Therapy, University of St. Augustine for Health Sciences, St. Augustine, Florida, USA
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Paterno MV, Fitzgerald GK. Booster visits in the management of the acute musculoskeletal injuries: Transforming care to improve outcomes-A perspective review. J Orthop Res 2024; 42:1151-1158. [PMID: 38597734 DOI: 10.1002/jor.25852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 02/22/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
The current healthcare delivery system for patients with acute musculoskeletal injury is failing. Current rehabilitation management of acute musculoskeletal injury typically includes physical therapy, focused on management of impairments, with an eventual transition to functional activities and release to prior level of function. At that point, formal physical therapy is often discontinued, despite the knowledge that a high percentage of patients fail to maintain preinjury level of activity and often reduce participation in regular physical activity. Further, for those who attempt to return to prior levels of pivoting and cutting activities, there is a high second injury rate. The long-term human experience is compromised by the current model of care which terminates at the point of transition to activity. This model of care fails to meet the continued needs of these patients and may result in long term deficits and potential disability. Extended care models include intermittent follow up visits after discharge from an acute episode of care and have been efficacious and cost effective in some patient populations with musculoskeletal conditions. Specifically, a type of extended care model, labeled "booster sessions," represents an opportunity to provide structured, intermittent care to assist in a smooth transition back to function, following an acute episode of care and promote a healthier life outcome. This perspective review will discuss the opportunity to transform acute musculoskeletal care to booster visit care model in an attempt to develop a more efficacious and cost-effective system of care which could be generalizable to all musculoskeletal conditions.
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Affiliation(s)
- Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap 2024; 32:17. [PMID: 38773515 PMCID: PMC11110311 DOI: 10.1186/s12998-024-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. PURPOSE The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. METHODS A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. CONCLUSIONS Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.
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Affiliation(s)
- Roger Kerry
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Edward Lee
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- Nottingham CityCare Partnership, Bennerley Rd, Nottingham, NG6 8WR, UK
| | - Vasileios Georgopoulos
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA, UK
| | - Adam Meakins
- Department of Orthopaedics, West Herts Hospitals Trust, Watford, WD18 0HB, UK
| | - Chris McCarthy
- School of Physiotherapy, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Chad Cook
- Department of Orthopaedics, Duke University, 200 Morris Street, Durham, NC, 27701, USA
| | - Colette Ridehalgh
- School of Sport and Health Sciences, University of Brighton, Darley Rd, Eastbourne, BN20 7UR, UK
- Clinical Neuroscience, Trafford Building, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Amanda Banton
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | | | - Firas Mourad
- Department of health, LUNEX, Differdange, 4671, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Adams KR, Famuyide AO, Young JL, Maddox CD, Rhon DI. Pragmatism in manual therapy trials for knee osteoarthritis: a systematic review. Arch Physiother 2024; 14:1-10. [PMID: 38444787 PMCID: PMC10898243 DOI: 10.33393/aop.2024.2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Manual therapy is an often-utilized intervention for the management of knee osteoarthritis (OA). The interpretation of results presented by these trials can be affected by how well the study designs align applicability to real-world clinical settings. Aim To examine the existing body of clinical trials investigating manual therapy for knee OA to determine where they fall on the efficacy-effectiveness spectrum. Methods This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials that investigated manual therapy treatments for adults with knee OA were retrieved via searches of multiple databases to identify trials published prior to April 2023. The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool was used to objectively rate the efficacy-effectiveness nature of each trial design. The Cochrane Risk of Bias 2.0 assessment tool (RoB-2) was used to assess the risk of bias across five domains. Results Of the 36 trials, a higher percentage of trials had a greater emphasis on efficacy within all four domains: participant characteristics (75.0%), trial setting (77.8%), flexibility of intervention (58.3%), and clinical relevance of experimental and comparison intervention (47.2%). In addition, 13.9% of the trials had low risk of bias, 41.7% had high risk of bias, and 44.4% had some concerns regarding bias. Conclusions While many trials support manual therapy as effective for the management of knee OA, a greater focus on study designs with an emphasis on effectiveness would improve the applicability and generalizability of future trials.
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Affiliation(s)
- Kyle R. Adams
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Department of Physical Therapy, Baylor University, Waco, Texas - USA
| | - Ayodeji O. Famuyide
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Greater Baton Rouge Physical Therapy, Baton Rouge, Louisiana - USA
| | - Jodi L. Young
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
| | - C. Daniel Maddox
- Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, Georgia - USA
- Upstream Rehab Institute, Smyrna, Georgia - USA
| | - Daniel I. Rhon
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin - USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland - USA
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Smith T, Singh G, Mcnamee G, Newton C. Musculoskeletal physiotherapists' discharge practices for people treated with low back pain: A United Kingdom survey. Musculoskeletal Care 2023. [PMID: 38036768 DOI: 10.1002/msc.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Persistent low back pain (LBP) is the leading cause of disability, and a major burden on the healthcare system globally. Many people with LBP experience recurrent pain flares and receive repeated appointments and re-referrals to services such as physiotherapy. However, it is not clear what the criteria are for discharging people with LBP from physiotherapy services. This study aims to describe the current practices for discharging people from physiotherapy for LBP in the United Kingdom (UK). METHODS A cross-sectional study using an anonymous online national (UK) survey was conducted among qualified physiotherapists who treat people with LBP in UK musculoskeletal out-patient services. RESULTS A total of 104 surveys were completed. The majority of respondents reported using (i) a shared decision-making (77%) and (ii) person-physiotherapist goal attainment (74%) approach to discharging people with LBP. Sixty-three percent of respondents reported using a patient-initiated follow-up (PIFU) approach. Only 8% of respondents reported using a graded discharge approach with 'booster' appointments. A PIFU or graded discharge approach was considered most pertinent for people at higher risk of a pain flare (97%; 86%) and with low self-efficacy to self-manage their LBP. CONCLUSIONS This UK survey established that discharge practices for people with LBP after physiotherapy vary. Whilst the majority of people are currently discharged with a PIFU appointment, a graded discharge approach may be more beneficial for people who are less likely to initiate a PIFU appointment. Further consideration on the development of such a pathway is now required.
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Affiliation(s)
- Toby Smith
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - George Mcnamee
- Physiotherapy Department, University Hospitals Coventry and Warwickshire, Coventry, UK
- School of Health and Care, University of Coventry, Coventry, UK
| | - Christopher Newton
- Physiotherapy Department, University Hospitals Coventry and Warwickshire, Coventry, UK
- School of Health and Care, University of Coventry, Coventry, UK
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Rhon DI, Flynn TW, Shepherd MH, Abbott JH. Leveraging the Short-Term Benefits of Manual Therapy which Includes Exercise Over Exercise Therapy Alone Appears Justified for Knee Osteoarthritis. J Orthop Sports Phys Ther 2023; 53:49-50. [PMID: 36587263 DOI: 10.2519/jospt.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Letter to the Editor-in-Chief in response to JOSPT article "The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients with Knee or Hip Osteoarthritis: A Systematic Review with Meta-analysis" by Runge et al. J Orthop Sports Phys Ther 2023;53(1):49-50. doi:10.2519/jospt.2023.0201.
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Bell EC, Wallis JA, Goff AJ, Crossley KM, O'Halloran P, Barton CJ. Does land-based exercise-therapy improve physical activity in people with knee osteoarthritis? A systematic review with meta-analyses. Osteoarthritis Cartilage 2022; 30:1420-1433. [PMID: 35970256 DOI: 10.1016/j.joca.2022.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
PRIMARY OBJECTIVE Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA). DESIGN Systematic review and meta-analysis of randomised or quasi-randomised trials investigating land-based exercise-therapy on physical activity, fitness, and general health in people with KOA. We updated a 2013 Cochrane review search on exercise-therapy for KOA in April 2021 and applied the Cochrane Risk-of-Bias Tool 1.0 to included articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. GRADE was used to assess certainty of the evidence. RESULTS Twenty-eight randomised controlled trials (2,789 participants) evaluating the effects of resistance-training (n = 10), walking (n = 6) and mixed-exercise programs (n = 7) were identified. Low to moderate certainty evidence indicated small increases in physical activity for exercise-therapy compared to non-exercise interventions in the short-term (SMD, 95% CI = 0.29, 0.09 to 0.50), but not the medium- (0.03, -0.11 to 0.18) or long-term (-0.06, -0.34 to 0.22). Low certainty evidence indicated large increases in physical activity for walking programs (0.53, 0.11 to 0.95) and mixed-exercise programs (0.67, 0.37 to 0.97) compared to non-exercise interventions in the short-term. Low certainty evidence indicated moderate and small increases in physical activity for resistance-training combined with education focused on pain coping skills and self-efficacy compared to education alone at medium-term follow-up (0.45, 0.19 to 0.71). CONCLUSION Walking and mixed-exercise, but not resistance-training, may improve physical activity in people with KOA in the short-term. Combining resistance-training with education may increase physical activity in the medium-, but not the long-term, highlighting the potential importance of developing more effective longer-term interventions for people with KOA. Future studies evaluating land-based exercise-therapy are encouraged to include physical activity outcomes and longer-term follow-up to increase the certainty of evidence.
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Affiliation(s)
- E C Bell
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - J A Wallis
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Australia
| | - A J Goff
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - K M Crossley
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - P O'Halloran
- La Trobe University School of Psychology and Public Health, Australia
| | - C J Barton
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Australia
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Kjeldsen T, Dalgas U, Skou ST, van Tulder M, Bibby BM, Mechlenburg I. Progressive resistance training compared to neuromuscular exercise in patients with hip osteoarthritis and the additive effect of exercise booster sessions: protocol for a multicentre cluster randomised controlled trial (The Hip Booster Trial). BMJ Open 2022; 12:e061053. [PMID: 36109033 PMCID: PMC9478855 DOI: 10.1136/bmjopen-2022-061053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The primary aim of this randomised controlled trial is to investigate the effectiveness of 3 months of progressive resistance training (PRT) compared to neuromuscular exercise (NEMEX) on functional performance in patients with hip osteoarthritis (OA). Secondary aims are to investigate the effectiveness of exercise booster sessions (EBS) in prolonging the effects of the initial exercise interventions as well as to investigate the cost-effectiveness of PRT, NEMEX and EBS at 12-month follow-up. METHODS AND ANALYSIS This multicentre cluster randomised controlled trial will be conducted at hospitals and physiotherapy clinics across Denmark. A total of 160 participants with clinically diagnosed hip OA will be recruited. Participants will be cluster randomised to a 3-month intervention of either PRT or NEMEX and to receive EBS or not, resulting in four treatment arms.The primary outcome is change in functional performance, measured by the 30 s chair stand test at 3 months for the primary comparison and at 12 months for the EBS comparisons. Secondary outcomes include changes in 40 m fast-paced walk test, 9-step timed stair climb test, leg extensor muscle power and maximal strength, Hip disability and Osteoarthritis Outcome Score subscales, EuroQol Group 5-dimension, global perceived effect, physical activity and pain. Outcomes are measured at baseline, after the initial 3 months of intervention, and at 6-month, 9-month and 12-month follow-up. An intention-to-treat approach will be used for analysing changes in the primary and secondary outcome measures. ETHICS AND DISSEMINATION The trial has been approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-267-20) and registered at the Danish Data Protection Agency (Journal No 1-16-02-11-21). Results will be published in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04714047.
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Affiliation(s)
- Troels Kjeldsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Maurits van Tulder
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Bo M Bibby
- Department of Biostatistics, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Kaufman BG, Allen KD, Coffman CJ, Woolson S, Caves K, Hall K, Hoenig HM, Huffman KM, Morey MC, Hodges NJ, Ramasunder S, van Houtven CH. Cost and Quality of Life Outcomes of the STepped Exercise Program for Patients With Knee OsteoArthritis Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:614-621. [PMID: 35365305 DOI: 10.1016/j.jval.2021.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response. Intervention costs were assessed from the VA perspective. Quality of life (QOL) was measured using 5-level EQ-5D US utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in quality-adjusted life-years (QALYs) between arms at 9 months. A Monte Carlo probabilistic sensitivity analysis was used to generate a cost-effectiveness acceptability curve. RESULTS The adjusted model found differential improvement in QOL utility weights of 0.042 (95% confidence interval 0.003-0.080; P=.03) for STEP-KOA versus control at 9 months. In the base case, STEP-KOA resulted in an incremental gain of 0.028 QALYs and an incremental cost of $279 per patient for an ICER of $10 076. One-way sensitivity analyses found the largest sources of variation in the ICER were the impact on QOL and the need for a VA-owned tablet. The probabilistic sensitivity analysis found a 98% probability of cost-effectiveness at $50 000 willingness-to-pay per QALY. CONCLUSIONS STEP-KOA improves QOL and has a high probability of cost-effectiveness. Resources needed to implement the program will decline as ownership of mobile health devices increases.
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Affiliation(s)
- Brystana G Kaufman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA.
| | - Kelli D Allen
- Durham VA Medical Center, Durham, NC, USA; University of North Carolina, Chapel Hill, NC
| | - Cynthia J Coffman
- Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin Caves
- Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Katherine Hall
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Helen M Hoenig
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Kim M Huffman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Miriam C Morey
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
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Rhon DI, Kim M, Asche CV, Allison SC, Allen CS, Deyle GD. Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis: A Secondary Analysis From a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2142709. [PMID: 35072722 PMCID: PMC8787617 DOI: 10.1001/jamanetworkopen.2021.42709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Physical therapy and glucocorticoid injections are initial treatment options for knee osteoarthritis, but available data indicate that most patients receive one or the other, suggesting they may be competing interventions. The initial cost difference for treatment can be substantial, with physical therapy often being more expensive at the outset, and cost-effectiveness analysis can aid patients and clinicians in making decisions. OBJECTIVE To investigate the incremental cost-effectiveness between physical therapy and intra-articular glucocorticoid injection as initial treatment strategies for knee osteoarthritis. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation is a secondary analysis of a randomized clinical trial performed from October 1, 2012, to May 4, 2017. Health economists were blinded to study outcomes and treatment allocation. A randomized sample of patients seen in primary care and physical therapy clinics with a radiographically confirmed diagnosis of knee osteoarthritis were evaluated from the clinical trial with 96.2% follow-up at 1 year. INTERVENTIONS Physical therapy or glucocorticoid injection. MAIN OUTCOMES AND MEASURES The main outcome was incremental cost-effectiveness between 2 alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICERs) were used to identify the proportion of ICERs under the specific willingness-to-pay level ($50 000-$100 000). Health care system costs (total and knee related) and health-related quality-of-life based on quality-adjusted life-years (QALYs) were obtained. RESULTS A total of 156 participants (mean [SD] age, 56.1 [8.7] years; 81 [51.9%] male) were randomized 1:1 and followed up for 1 year. Mean (SD) 1-year knee-related medical costs were $2113 ($4224) in the glucocorticoid injection group and $2131 ($1015) in the physical therapy group. The mean difference in QALY significantly favored physical therapy at 1 year (0.076; 95% CI, 0.02-0.126; P = .003). Physical therapy was the more cost-effective intervention, with an ICER of $8103 for knee-related medical costs, with a 99.2% probability that results fall below the willingness-to-pay threshold of $100 000. CONCLUSIONS AND RELEVANCE A course of physical therapy was cost-effective compared with a course of glucocorticoid injections for patients with knee osteoarthritis. These results suggest that, although the initial cost of delivering physical therapy may be higher than an initial course of glucocorticoid injections, 1-year total knee-related costs are equivalent, and greater improvement in QALYs may justify the initial higher costs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01427153.
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Affiliation(s)
- Daniel I. Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Minchul Kim
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria
| | - Carl V. Asche
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria
| | - Stephen C. Allison
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
| | - Chris S. Allen
- Department of Rehabilitation, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Gail D. Deyle
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
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Are manual therapy or booster sessions worthwhile in addition to exercise therapy for knee osteoarthritis: Economic evaluation and 2-year follow-up of a randomized controlled trial. Musculoskelet Sci Pract 2021; 56:102439. [PMID: 34375855 DOI: 10.1016/j.msksp.2021.102439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exercise therapy is known to be an effective intervention for patients with osteoarthritis, however the evidence is limited as to whether adding manual therapy or booster sessions are cost-effective strategies to extend the duration of benefits. OBJECTIVE To investigate the cost-effectiveness, at 2-year follow-up, of adding manual therapy and/or booster sessions to exercise therapy. DESIGN 2-by-2 factorial randomized controlled trial. METHODS Participants with knee osteoarthritis were randomly allocated (1:1:1:1) to: exercise therapy delivered in consecutive sessions within 9 weeks (control group), exercise therapy distributed over 1 year using booster sessions, exercise therapy plus manual therapy delivered within 9 weeks, and exercise therapy plus manual therapy with booster sessions. The primary outcome was incremental cost-effectiveness from health system and societal perspectives interpreted as incremental net monetary benefit (INMB). RESULTS Of 75 participants, 66 (88 %) were retained at 1-year and 40 (53 %) at 2-year follow-up. All three interventions were cost-effective from both the health system and societal perspectives (INMBs, at 0.5 × GDP/capita willingness to pay (WTP) threshold: $3278 (95%CI -3244 to 9800) and $3904 (95%CI -2823 to 10,632) respectively for booster sessions; $2941 (95%CI -3686 to 9568) and $2618 (95%CI -4005 to 9241) for manual therapy; $270 (95%CI -6139 to 6679) and $404 (95%CI -6097 to 6905) for manual therapy with booster sessions). CONCLUSION Manual therapy or booster sessions in addition to exercise therapy are cost-effective at 2-year follow-up. The evidence did not support combining both booster sessions and manual therapy in addition to exercise therapy.
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Taul-Madsen L, Kjeldsen T, Skou ST, Mechlenburg I, Dalgas U. Exercise booster sessions as a mean to maintain the effect of an exercise-intervention - A systematic review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1988816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Laurits Taul-Madsen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels Kjeldsen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Readinger J, Eastlack M, Von Nieda K, Kantak S, Sawyer K. Feasibility and longitudinal effects of repeated participation in an annual, brief and intense exercise program in individuals with Parkinson's disease: A case report. Physiother Theory Pract 2021; 38:3194-3205. [PMID: 34313192 DOI: 10.1080/09593985.2021.1952667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Functional decline is expected over time in persons with Parkinson's disease (PD). Intense exercise (RPE ≥ 5-7/10), incorporating motor learning principles, may be beneficial. Purpose:The purpose of this case report is to describe the feasibility and longitudinal effects after individuals with PD participated in multiple, 3.5-day, intensive exercise programs called Movement Camp (Camp). METHODS Developed based on the principles of skill, capacity, and motivation, the Camp was offered four times (spring 2014-spring 2017) over the course of three years. Camp consisted of 3.5 days, with approximately 5.5 hours of exercise per day. The four participants on whom we are reporting were selected because they participated in three or more Camps, thus providing longitudinal data. Participants rotated through high-intensity, one-hour exercise stations targeting balance, endurance, gait, upper extremity function and three 30-minute group training sessions. Balance (Mini-BESTest), endurance (six-minute walk test), gait speed, and function (five times sit-to-stand) were examined. RESULTS Testing was completed prior to, post, and six weeks post intervention. Over three years, participants maintained or improved performance on most measures. CONCLUSION The outcomes of this case report suggest that brief, intensive exercise based on motor learning principles is feasible and may maintain or improve function in persons with PD over three years.
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Affiliation(s)
- Janet Readinger
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Marty Eastlack
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Kristin Von Nieda
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Shailesh Kantak
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Karen Sawyer
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
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Diabetes Mellitus Blunts the Symptoms, Physical Function, and Health-Related Quality of Life Benefits of Total Knee Arthroplasty: A Systematic Review With Meta-analysis of Data From More Than 17 000 Patients. J Orthop Sports Phys Ther 2021; 51:269-280. [PMID: 33870736 DOI: 10.2519/jospt.2021.9515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare physical function, pain, impairments (stiffness, range of motion, and strength), and health-related quality of life (HRQoL) outcomes between patients with and without diabetes mellitus, before and after a total knee arthroplasty (TKA). DESIGN Prognosis systematic review. LITERATURE SEARCH We searched MEDLINE/PubMed, CINAHL, SPORTDiscus, and Web of Science to August 2019. STUDY SELECTION CRITERIA We included longitudinal studies that examined physical function, pain, impairments, and HRQoL outcomes among patients receiving a TKA and with or without diabetes. DATA SYNTHESIS For quantitative synthesis, we stratified outcomes based on time relative to TKA: preoperative, less than 1 year after a TKA (early postoperative), and 1 year or more after a TKA (late postoperative). We used random-effects meta-analysis to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation system for qualitative synthesis. RESULTS We included 21 studies (n = 17 472 patients). Patients with diabetes mellitus had worse preoperative physical function (SMD, -0.16; 95% CI: -0.24, -0.08) and HRQoL (SMD, -0.16; 95% CI: -0.26, -0.05), worse early postoperative pain (SMD, -0.22; 95% CI: -0.39, -0.05) and strength (SMD, -0.45; 95% CI: -0.77, -0.14), and worse late postoperative physical function (SMD, -0.23; 95% CI: -0.40, -0.06), range of motion (SMD, -0.23; 95% CI: -0.46, 0.00), and HRQoL (SMD, -0.19; 95% CI: -0.29, -0.08) than patients without diabetes mellitus. The overall risk of bias across studies was high, and the certainty of evidence ranged from low to very low. CONCLUSION Patients with diabetes mellitus had worse patient-reported and clinician-assessed outcomes before and after a TKA. Given the limitations of included studies, these results may change with future research. J Orthop Sports Phys Ther 2021;51(6):269-280. Epub 19 Apr 2021. doi:10.2519/jospt.2021.9515.
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George SZ, Giczewska A, Alhanti B, Lutz AD, Shanley E, Thigpen CA, Bhavsar NA. Predicting Recurrent Care Seeking of Physical Therapy for Musculoskeletal Pain Conditions. PAIN MEDICINE 2021; 22:1837-1849. [PMID: 33905514 DOI: 10.1093/pm/pnab154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Musculoskeletal pain conditions are a leading cause of pain and disability internationally and a common reason to seek health care. Accurate prediction of recurrence of health care seeking due to musculoskeletal conditions could allow for better tailoring of treatment. The aim of this project was to characterize patterns of recurrent physical therapy seeking for musculoskeletal pain conditions and to develop a preliminary prediction model to identify those at increased risk of recurrent care seeking. DESIGN Retrospective cohort. SETTING Ambulatory care. SUBJECTS Patients (n = 578,461) seeking outpatient physical therapy (United States). METHODS Potential predictor variables were extracted from the electronic medical record, and patients were placed into three different recurrent care categories. Logistic regression models were used to identify individual predictors of recurrent care seeking, and the least absolute shrinkage and selection operator (LASSO) was used to develop multivariate prediction models. RESULTS The accuracy of models for different definitions of recurrent care ranged from 0.59 to 0.64 (c-statistic), and individual predictors were identified from multivariate models. Predictors of increased risk of recurrent care included receiving workers' compensation and Medicare insurance, having comorbid arthritis, being postoperative at the time of the first episode, age range of 44-64 years, and reporting night sweats or night pain. Predictors of decreased risk of recurrent care included lumbar pain, chronic injury, neck pain, pregnancy, age range of 25-44 years, and smoking. CONCLUSION This analysis identified a preliminary predictive model for recurrence of care seeking of physical therapy, but model accuracy needs to improve to better guide clinical decision-making.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery.,Duke Clinical Research Institute
| | | | | | - Adam D Lutz
- ATI Physical Therapy, Chicago, Illinois, USA
| | | | | | - Nrupen A Bhavsar
- Division of General Internal Medicine, Duke University, Durham, North Carolina
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Mazzei DR, Ademola A, Abbott JH, Sajobi T, Hildebrand K, Marshall DA. Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review. Osteoarthritis Cartilage 2021; 29:456-470. [PMID: 33197558 DOI: 10.1016/j.joca.2020.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/08/2020] [Accepted: 10/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.
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Affiliation(s)
- D R Mazzei
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - A Ademola
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand.
| | - T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - K Hildebrand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - D A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Zhao T, Ahmad H, de Graaff B, Xia Q, Winzenberg T, Aitken D, Palmer AJ. Systematic Review of the Evolution of Health-Economic Evaluation Models of Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 73:1617-1627. [PMID: 32799431 DOI: 10.1002/acr.24410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 08/04/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To comprehensively synthesize the evolution of health-economic evaluation models (HEEMs) of all osteoarthritis (OA) interventions, including preventions, core treatments, adjunct nonpharmacologic interventions, pharmacologic interventions, and surgical treatments. METHODS The literature was searched within health-economic/biomedical databases. Data extracted included OA type, population characteristics, model setting/type/events, study perspective, and comparators; the reporting quality of the studies was also assessed. The review protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018092937). RESULTS Eighty-eight studies were included. Pharmacologic and surgical interventions were the focus in 51% and 44% of studies, respectively. Twenty-four studies adopted a societal perspective (with increasing popularity after 2013), but most (63%) did not include indirect costs. Quality-adjusted life years was the most popular outcome measure since 2008. Markov models were used by 62% of studies, with increasing popularity since 2008. Until 2010, most studies used short-to-medium time horizons; subsequently, a lifetime horizon became popular. A total of 86% of studies reported discount rates (predominantly between 3% and 5%). Studies published after 2002 had a better coverage of OA-related adverse events (AEs). Reporting quality significantly improved after 2001. CONCLUSION OA HEEMs have evolved and improved substantially over time, with the focus shifting from short-to-medium-term pharmacologic decision-tree models to surgical-focused lifetime Markov models. Indirect costs of OA are frequently not considered, despite using a societal perspective. There was a lack of reporting sensitivity of model outcome to input parameters, including discount rate, OA definition, and population parameters. While the coverage of OA-related AEs has improved over time, it is still not comprehensive.
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Affiliation(s)
- Ting Zhao
- University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- University of Tasmania, Hobart, Tasmania, Australia
| | | | - Qing Xia
- University of Tasmania, Hobart, Tasmania, Australia
| | | | - Dawn Aitken
- University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- University of Tasmania, Hobart, Tasmania, and The University of Melbourne, Parkville, Victoria, Australia
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Increasing Physical Therapy Visits as a Marker for Time Lost From Work and High Workers' Compensation Claim Costs. J Occup Environ Med 2020; 62:e328-e333. [PMID: 32730036 DOI: 10.1097/jom.0000000000001891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the association between physical therapy (PT) visits and workers' compensation costs and lost time. METHOD A total of 40,203 lost-time claims (1998 to 2018) were analyzed. RESULTS The odds ratio of total paid claim costs more than or equal to $100,000 increased with the number of PT visits from 1.91 with 1 to 3 PT visits (95% confidence interval [CI]: 1.62 to 2.26) to 5.56 (95% CI: 4.86 to 6.37) for workers with a surgical procedure and more than or equal to 50 PT visits versus those without PT visits, when controlling for confounding factors. The risk of remaining at an off work status is greatest among claims involving surgery, escalating among claims with 15 or more PT visits (hazard ratio more than or equal to 3.76). CONCLUSIONS PT visits may be used as a marker for high workers' compensation cost and delayed return-to-work.
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Skou ST, Roos EM, Laursen M, Arendt-Nielsen L, Rasmussen S, Simonsen O, Ibsen R, Larsen AT, Kjellberg J. Cost-effectiveness of 12 weeks of supervised treatment compared to written advice in patients with knee osteoarthritis: a secondary analysis of the 2-year outcome from a randomized trial. Osteoarthritis Cartilage 2020; 28:907-916. [PMID: 32243994 DOI: 10.1016/j.joca.2020.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/01/2020] [Accepted: 03/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the 24-month cost-effectiveness of supervised treatment compared to written advice in knee osteoarthritis (OA). DESIGN 100 adults with moderate-severe OA not eligible for total knee replacement (TKR) randomized to a 12-week individualized, supervised treatment (exercise, education, diet, insoles and pain medication) or written advice. Effectiveness was measured as change in quality-adjusted life years (QALYs) from baseline to 24 months, including data from baseline, 3, 6, 12 and 24 months, while healthcare costs and transfer payments were derived from national registries after final follow-up. Incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. A sensitivity analysis resampling existing data was conducted and the probability of cost-effectiveness was estimated using a 22,665 Euros/QALY threshold. In a sensitivity analysis, cost-effectiveness was calculated for different costs of the supervised treatment (actual cost in study; cost in private practice; and in-between cost). RESULTS Average costs were similar between groups (6,758 Euros vs 6,880 Euros), while the supervised treatment were close to being more effective (incremental effect (95% CI) of 0.075 (-0.005 to 0.156). In the primary analysis excluding deaths, this led the supervised treatment to be cost-effective, compared to written advice. The sensitivity analysis demonstrated that the results were sensitive to changes in the cost of treatment, but in all scenarios the supervised treatment was cost-effective (ICERs of 6,229 to 20,688 Euros/QALY). CONCLUSIONS From a 24-month perspective, a 12-week individualized, supervised treatment program is cost-effective compared to written advice in patients with moderate-severe knee OA not eligible for TKR. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01535001.
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Affiliation(s)
- S T Skou
- Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, 9000, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, 4200, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, 9220, Denmark.
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
| | - M Laursen
- Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, 9000, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, 9220, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, 9220, Denmark
| | - L Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, 9220, Denmark
| | - S Rasmussen
- Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, 9000, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, 9220, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, 9220, Denmark
| | - O Simonsen
- Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, 9000, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, 9220, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, 9220, Denmark
| | - R Ibsen
- I2minds, Aarhus, 8000, Denmark
| | - A T Larsen
- VIVE - The Danish Centre of Applied Social Science, Copenhagen, 1150, Denmark
| | - J Kjellberg
- VIVE - The Danish Centre of Applied Social Science, Copenhagen, 1150, Denmark
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Deyle GD, Allen CS, Allison SC, Gill NW, Hando BR, Petersen EJ, Dusenberry DI, Rhon DI. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med 2020; 382:1420-1429. [PMID: 32268027 DOI: 10.1056/nejmoa1905877] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Both physical therapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain. METHODS We conducted a randomized trial to compare physical therapy with glucocorticoid injection in the primary care setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physical therapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test, the time needed to complete the Timed Up and Go test, and the score on the Global Rating of Change scale, all assessed at 1 year. RESULTS We enrolled 156 patients with a mean age of 56 years; 78 patients were assigned to each group. Baseline characteristics, including severity of pain and level of disability, were similar in the two groups. The mean (±SD) baseline WOMAC scores were 108.8±47.1 in the glucocorticoid injection group and 107.1±42.4 in the physical therapy group. At 1 year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively (mean between-group difference, 18.8 points; 95% confidence interval, 5.0 to 32.6), a finding favoring physical therapy. Changes in secondary outcomes were in the same direction as those of the primary outcome. One patient fainted while receiving a glucocorticoid injection. CONCLUSIONS Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection. (ClinicalTrials.gov number, NCT01427153.).
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Affiliation(s)
- Gail D Deyle
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Chris S Allen
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Stephen C Allison
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Norman W Gill
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Benjamin R Hando
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Evan J Petersen
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Douglas I Dusenberry
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
| | - Daniel I Rhon
- From Brooke Army Medical Center (G.D.D., S.C.A., N.W.G., D.I.D., D.I.R.), the Special Warfare Training Wing, U.S. Air Force (B.R.H.), and the University of the Incarnate Word (E.J.P.) - all in San Antonio, TX; the College of Allied Health Sciences, University of Cincinnati, Cincinnati (C.S.A.); and Madigan Army Medical Center, Tacoma, WA (D.I.R.)
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22
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The Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers' Compensation System. J Occup Environ Med 2019; 61:635-640. [PMID: 31090676 DOI: 10.1097/jom.0000000000001630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Physical therapy (PT) is perceived as a cost driver in the US workers' compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers' compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers' compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.
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23
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Peiffer V, Yock CA, Yock PG, Pietzsch JB. Value-Based Care: A Review of Key Challenges and Opportunities Relevant to Medical Technology Innovators. J Med Device 2019. [DOI: 10.1115/1.4042794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Developed countries struggle with high healthcare spending, and cost is often cited as a barrier to the introduction of new patient care technologies. The core objective of this review article is to help familiarize medical technology innovators with trends in the health economic environment and the implications for the adoption of new technologies. We review and discuss this topic in language accessible to medical technology innovators. We assess macrolevel developments in healthcare spending and highlight measures already taken to control spending. We discuss practical implications for anyone involved in healthcare innovation. Two observations are central to this discussion: (1) the U.S. spends significantly more on healthcare per capita than any other developed country; (2) across developed countries, healthcare spending has risen steadily over the past two decades. Nevertheless, higher spending has not always led to improvements in health. As a result, innovators need to be prepared to navigate an outcomes-oriented and value-based environment that is being defined by the emerging requirements of various healthcare stakeholders. Practically, new products should aim to improve health outcomes at a cost deemed “good value” and/or reduce cost for one or multiple stakeholders. Opportunities also exist for tools that enable cost/outcomes tracking, which will help demonstrate value to providers, insurers, and patients.
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Affiliation(s)
| | - Cynthia A. Yock
- Byers Center for Biodesign, Stanford University, Stanford, CA 94305
| | - Paul G. Yock
- Byers Center for Biodesign, Stanford University, Stanford, CA 94305
| | - Jan B. Pietzsch
- Wing Tech, Inc., Menlo Park, CA 94025; Byers Center for Biodesign, Stanford University, Clark Center (E100) 318 Campus Drive, Stanford, CA 94305 e-mail:
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24
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Abbott JH, Wilson R, Pinto D, Chapple CM, Wright AA. Incremental clinical effectiveness and cost effectiveness of providing supervised physiotherapy in addition to usual medical care in patients with osteoarthritis of the hip or knee: 2-year results of the MOA randomised controlled trial. Osteoarthritis Cartilage 2019; 27:424-434. [PMID: 30553932 DOI: 10.1016/j.joca.2018.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the clinical- and cost-effectiveness at 2-year follow-up of providing individual, supervised exercise physiotherapy and/or manual physiotherapy in addition to usual medical care. METHOD People with hip or knee osteoarthritis meeting the American College of Rheumatology clinical diagnostic criteria were randomised (1:1, concealed, assessor-blinded) to four groups: usual medical care; supervised exercise physiotherapy; manual physiotherapy; or combined exercise and manual physiotherapy. Physiotherapy group participants were provided 10 50-min treatment sessions including booster sessions at 4 and 13 months, in addition to usual care. The primary outcome at 2-year follow-up was incremental cost-utility ratio (ICUR) of each physiotherapy intervention in addition to usual care, compared with usual care alone, from the health system and societal perspectives. To allow interpretation of negative ICURs, we report incremental net benefit (INB). The primary clinical outcome was the Western Ontario and McMaster Osteoarthritis Index (WOMAC). RESULTS Of 206 patients, 186 (90·3%) were retained at 2-year follow-up. Exercise physiotherapy and manual physiotherapy dominated usual care, demonstrating cost savings; combined therapy did not. Exercise therapy had the highest incremental net benefits (INBs), statistically significant at all willingness-to-pay (base-case: societal New Zealand (NZ)$6,312, 95%CI 334 to 12,279; health system NZ$8,065, 95%CI 136 to 15,994). Clinical improvements were superior to usual care only in the exercise physiotherapy group (-28.2 WOMAC points, 95%CI -49.2 to -7.1). No serious adverse events were recorded. CONCLUSION Individually supervised exercise therapy is cost-effective and clinically effective in addition to usual medical care at 2-year follow-up, and leads to cost savings for the health system and society. TRIAL REGISTRATION Prospectively registered with the Australian NZ Clinical Trials Registry, reference ACTRN12608000130369.
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Affiliation(s)
- J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - R Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
| | - D Pinto
- College of Health Sciences, Program in Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - C M Chapple
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, 9054, New Zealand.
| | - A A Wright
- Department of Physical Therapy, High Point University, High Point, NC, USA.
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25
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Uesugi Y, Koyanagi J, Takagi K, Yamaguchi R, Hayashi S, Nishii T. Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions. JMIR Rehabil Assist Technol 2018; 5:e10. [PMID: 29735473 PMCID: PMC5962826 DOI: 10.2196/rehab.8251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 02/01/2018] [Accepted: 03/14/2018] [Indexed: 01/03/2023] Open
Abstract
Background Prevalence of developmental hip dysplasia is high in Japan. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via digital video discs (DVDs) and websites allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders. Objective This study aimed to compare the effectiveness of exercise therapy administered via DVD and that administered via a website. Methods We developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of open kinetic chain and closed kinetic chain exercises. Once the program was developed, exercise DVDs were produced. In addition to the six-step exercise program, our website was enabled to count the number of exercises performed by each patient and was accessible via the Internet at any time. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital in the Kansai area in Japan. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed preintervention and after 6 months. Results At 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3, SD 16.1 years) and 18 website users (2 male, 16 female; mean age 52.4, SD 10.4 years) were reachable. The change in each parameter could not be confirmed a significant improvement. However, most items tended to reflect overall improvement during the 6 months of intervention (P=.05-.94; paired t test). Regarding effect size, we considered a small effect to be greater than 0.2. Little effect was observed for JHEQ pain, SF-8 physical component summary (PCS), and SF-8 mental component summary in the DVD group, as well as OHS, SF-8 (PCS), and GSES in the website group. Conclusions When comparing the effectiveness of exercise therapy between our DVD and website, we found that although both groups tended to improve in physical function, only the website group showed tendency of enhanced self-efficacy.
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Affiliation(s)
- Yuko Uesugi
- International Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Junichiro Koyanagi
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Keishi Takagi
- Department of Rehabilitation, Osaka University Hospital, Suita, Japan
| | | | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Nishii
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
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