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Kajos LF, Molics B, Elmer D, Pónusz-Kovács D, Kovács B, Horváth L, Csákvári T, Bódis J, Boncz I. Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data. BMC Musculoskelet Disord 2024; 25:406. [PMID: 38783258 PMCID: PMC11112791 DOI: 10.1186/s12891-024-07513-y] [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: 11/05/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Health services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data. METHODS Data were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013). RESULTS Based on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30-39, 40-49, 50-59, 60-69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women. CONCLUSIONS The prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.
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Affiliation(s)
- Luca Fanni Kajos
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
- National Laboratory On Human Reproduction, University of Pécs, Pécs, Hungary.
| | - Bálint Molics
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Diána Elmer
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- National Laboratory On Human Reproduction, University of Pécs, Pécs, Hungary
| | - Dalma Pónusz-Kovács
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- National Laboratory On Human Reproduction, University of Pécs, Pécs, Hungary
| | - Bettina Kovács
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Lilla Horváth
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Tímea Csákvári
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- National Laboratory On Human Reproduction, University of Pécs, Pécs, Hungary
| | - József Bódis
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- National Laboratory On Human Reproduction, University of Pécs, Pécs, Hungary
- Department of Obstetrics and Gynaecology, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- National Laboratory On Human Reproduction, University of Pécs, Pécs, Hungary
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Biskupiak Z, Ha VV, Rohaj A, Bulaj G. Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases. J Clin Med 2024; 13:403. [PMID: 38256537 PMCID: PMC10816409 DOI: 10.3390/jcm13020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug-device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug-device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies.
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Affiliation(s)
- Zack Biskupiak
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Victor Vinh Ha
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84113, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Walter MM, Sirard P, Nero H, Hörder H, Dahlberg LE, Tveter AT, Kjeken I, Kiadaliri A. Digitally delivered education and exercises for patients with hand osteoarthritis-An observational study. Musculoskeletal Care 2023; 21:1154-1160. [PMID: 37421256 DOI: 10.1002/msc.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
Hand osteoarthritis (OA) is a common form of OA, for which education and exercise are considered the first-line treatment. The aim of the present study was to examine pain and perceived hand function in participants following 3 months of digitally delivered first-line treatment for hand OA. Three-hundred-and-seventy-nine of 846 participants with clinical signs and symptoms of hand OA completed the study. The digital hand OA treatment program consists of video instructed daily exercises and patient education through text lessons. Pain (NRS, 0 no pain, 10 worst) was the primary outcome, and stiffness (NRS) and the Functional Index for Hand OsteoArthritis (FIHOA, 0 best, 30 worst) were among secondary outcomes. The McNemar test and linear mixed effect regression model were used to assess the changes in outcomes from baseline to 3-month. After three months, the digitally delivered program was associated with a significant decrease in pain intensity (mean change -1.30 (95% CI -1.49, -1.12)) and hand stiffness (mean change -0.81 (95% CI -1.02, -0.60)) but no conclusive changes in the FIHOA scores (mean change 0.3 (95% CI -0.2, 0.7)). The results agree with reports on face-to-face delivered first-line treatment for hand OA suggesting that digital treatment is a viable treatment option in patients with hand OA.
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Affiliation(s)
- Matthias Michael Walter
- Science and Research, Physio Insight, Haslach im Kinzigtal, Baden-Württemberg, Germany
- SRH Fachschule für Physiotherapie Stuttgart Ost, Suttgart, Germany
| | | | - Håkan Nero
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Helena Hörder
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Joint Academy®, Malmö, Sweden
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ali Kiadaliri
- Joint Academy®, Malmö, Sweden
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Bell EC, O'Halloran P, Wallis JA, Crossley KM, Gibbs AJ, Lee A, Jennings S, Barton CJ. Using SUpported Motivational InTerviewing (SUMIT) to increase physical activity for people with knee osteoarthritis: a pilot, feasibility randomised controlled trial. BMJ Open 2023; 13:e075014. [PMID: 37989380 PMCID: PMC10668304 DOI: 10.1136/bmjopen-2023-075014] [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] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the feasibility and effectiveness of using SUpported Motivational InTerviewing (SUMIT) to increase physical activity in people with knee osteoarthritis (KOA). DESIGN Randomised controlled trial. SETTING We recruited people who had completed Good Life with osteoArthritis Denmark (GLA:D) from private, public and community settings in Victoria, Australia. INTERVENTIONS Participants were randomised participants to receive SUMIT or usual care. SUMIT comprised five motivational interviewing sessions targeting physical activity over 10 weeks, and access to a multimedia web-based platform. PARTICIPANTS Thirty-two participants were recruited (17 SUMIT, 15 control) including 22 females (69%). OUTCOME MEASURES Feasibility outcomes included recruitment rate, adherence to motivational interviewing, ActivPAL wear and drop-out rate. Effect sizes (ESs) were calculated for daily steps, stepping time, time with cadence >100 steps per minute, time in bouts >1 min; 6 min walk distance, Knee Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, function, sport and recreation, and quality of life (QoL)), Euroqual, systolic blood pressure, body mass index, waist circumference, 30 s chair stand test and walking speed during 40 m walk test. RESULTS All feasibility criteria were achieved, with 32/63 eligible participants recruited over seven months; with all participants adhering to all motivational interviewing calls and achieving sufficient ActivPAL wear time, and only two drop-outs (6%).12/15 outcome measures showed at least a small effect (ES>0.2) favouring the SUMIT group, including daily time with cadence >100 steps per minute (ES=0.43). Two outcomes, walking speed (ES= 0.97) and KOOS QoL (ES=0.81), showed a large effect (ES>0.8). CONCLUSION SUMIT is feasible in people with knee osteoarthritis. Potential benefits included more time spent walking at moderate intensity, faster walking speeds and better QoL. TRIAL REGISTRATION NUMBER ACTRN12621000267853.
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Affiliation(s)
- Emily Catherine Bell
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, Cabrini Health, Malvern, Victoria, Australia
| | - Paul O'Halloran
- La Trobe University School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - Jason A Wallis
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, Cabrini Health, Malvern, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Alison J Gibbs
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - A Lee
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Sophie Jennings
- Department of Physiotherapy, Cabrini Health, Malvern, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Wörner T, Sirard P, Nero H, Hörder H, Misini Ignjatovic M, Eek F. Changes in pain and disability in patients with shoulder pain after three months of digitally delivered exercise and patient education. J Rehabil Med 2023; 55:jrm9415. [PMID: 38835146 PMCID: PMC10658804 DOI: 10.2340/jrm.v55.9415] [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: 02/07/2023] [Accepted: 10/09/2023] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To describe and examine potential predictors of changes in pain and disability in patients with shoulder pain who have completed 3 months of digitally delivered treatment comprising exercise and patient education. DESIGN Retrospective cohort study (clinicaltrials.org Nr: NCT05402514). SUBJECTS Patients with shoulder pain who completed treatment (n = 682). METHODS Primary outcome was change in shoulder pain (numerical rating scale 0-10; minimal clinical important change: at least 2 points). Pain and disability were reported on the Shoulder Pain and Disability Index. Changes in outcomes were analysed with paired sample t-tests. Association with potential predictors (sex, age, education, body mass index, physical activity, symptom duration, baseline pain/function, and treatment adherence) were explored with linear regression models Results: Statistically significant improvements were found for all treatment outcomes. Minimal clinically important change in pain was reached by 54.5% (n = 372). Higher baseline level of symptoms, short symptom duration, and high treatment adherence were associated with greater changes. CONCLUSION Patients with shoulder pain reported significant reductions in pain and disability following treatment, but the clinical relevance of the improvements has not been confirmed. Satisfactory treatment adherence, higher baseline pain and shorter symptom duration predicted larger improvements. A control group is needed to evaluate the actual effect of the treatment.
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Affiliation(s)
- Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden.
| | | | - Håkan Nero
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Helena Hörder
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | | | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
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Holm PM, Roos EM, Grønne DT, Skou ST. Online and onsite supervised exercise therapy and education for individuals with knee osteoarthritis - A before and after comparison of two different care delivery models. Musculoskeletal Care 2023; 21:878-889. [PMID: 37016749 DOI: 10.1002/msc.1765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To compare the 3 and 12-month changes on pain, function and quality of life between online and onsite delivery of Good Life with Osteoarthritis in Denmark (GLA:D® ) in individuals with knee osteoarthritis (OA). DESIGN Non-inferior comparison of individuals with knee OA receiving physiotherapist-supervised online (TeleGLA:D) or onsite (GLA:D®) (12 exercise and 2 education sessions). The primary outcome was the baseline-to-3-month change on KOOS-12 summary score. Secondary outcomes were changes in KOOS-12 subscales pain, function and quality of life and pain intensity (Visual Analog Scale (VAS 0-100)) at 3 and 12 months; 40 m fast-paced walk and 30 s chair-stand at 3 months. Using mixed linear regressions, comparisons were adjusted for age, sex, BMI, comorbidities and number of knees and hips with OA. RESULTS Over a 1-year period (May 2020-May 2021), we included data from 3789 participants (3701 GLA:D®; 88 TeleGLA:D). At 3 months, TeleGLA:D showed non-inferior change-scores to GLA:D® on KOOS-12 summary score; adjusted mean difference (90% Confidence Intervals (CI)) -2.40 (-5.55 to 0.75). For secondary outcomes, there was a statistically significant difference in change-scores, favouring TeleGLA:D in gait speed; adjusted mean difference (90%CI) 0.23 m/s (0.18-0.27). TeleGLA:D remained non-inferior to GLA:D® at 12 months. CONCLUSIONS Online delivery of physiotherapist-supervised neuromuscular exercise and education for individuals with knee OA may be non-inferior to traditional onsite delivery in reducing pain and improving function and quality of life. The wide confidence intervals, baseline imbalance, loss to follow-up and the non-randomized design highlight the need for a confirmatory randomized controlled trial.
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Affiliation(s)
- Paetur M Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-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
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-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
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Cunningham J, Doyle F, Ryan JM, Clyne B, Cadogan C, Cottrell E, Murphy P, Smith SM, French HP. Primary care-based models of care for osteoarthritis; a scoping review. Semin Arthritis Rheum 2023; 61:152221. [PMID: 37327762 DOI: 10.1016/j.semarthrit.2023.152221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To identify and describe the extent, nature, characteristics, and impact of primary care-based models of care (MoCs) for osteoarthritis (OA) that have been developed and/or evaluated. DESIGN Six electronic databases were searched from 2010 to May 2022. Relevant data were extracted and collated for narrative synthesis. RESULTS Sixty-three studies pertaining to 37 discrete MoCs from 13 countries were included, of which 23 (62%) could be classified as OA management programmes (OAMPs) comprising a self-management intervention to be delivered as a discrete package. Four models (11%) focussed on enhancing the initial consultation between a patient presenting with OA at the first point of contact into a local health system and the clinician. Emphasis was placed on educational training for general practitioners (GPs) and allied healthcare professionals delivering this initial consultation. The remaining 10 MoCs (27%) detailed integrated care pathways of onward referral to specialist secondary orthopaedic and rheumatology care within local healthcare systems. The majority (35/37; 95%) were developed in high-income countries and 32/37 (87%) targeted hip/and or knee OA. Frequently identified model components included GP-led care, referral to primary care services and multidisciplinary care. The models were predominantly 'one-size fits all' and lacked individualised care approaches. A minority of MoCs, 5/37 (14%) were developed using underlying frameworks, three (8%) of which incorporated behaviour change theories, while 13/37 (35%) incorporated provider training. Thirty-four of the 37 models (92%) were evaluated. Outcome domains most frequently reported included clinical outcomes, followed by system- and provider-level outcomes. While there was evidence of improved quality of OA care associated with the models, effects on clinical outcomes were mixed. CONCLUSION There are emerging efforts internationally to develop evidence-based models focused on non-surgical primary care OA management. Notwithstanding variations in healthcare systems and resources, future research should focus on model development alignment with implementation science frameworks and theories, key stakeholder involvement including patient and public representation, provision of training and education for providers, treatment individualisation, integration and coordination of services across the care continuum and incorporation of behaviour change strategies to foster long-term adherence and self-management.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer M Ryan
- Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | | | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Susan M Smith
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
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Tveter AT, Kleven L, Osteras N, Nossum R, Eide REM, Klokkeide Å, Matre KH, Olsen M, Kjeken I. Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial. BMJ Open 2023; 13:e063103. [PMID: 37355263 PMCID: PMC10314563 DOI: 10.1136/bmjopen-2022-063103] [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: 04/11/2022] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE The aim was to evaluate the cost-utility of a 3-month multimodal occupational therapy intervention in addition to usual care in patients with thumb carpometacarpal osteoarthritis (CMC1 OA). METHODS A cost-utility analysis was performed alongside a multicentre randomised controlled trial including three rheumatology departments in Norway. A total of 180 patients referred to surgical consultation due to CMC1 OA were randomised to either multimodal occupational therapy including patient education, hand exercises, assistive devices and orthoses (n=90), or usual care receiving only information on OA (n=90). The outcome measure was quality-adjusted life-years (QALYs) derived from the generic questionnaire EQ-5D-5L over a 2-year period. Resource use and health-related quality of life of the patients were prospectively collected at baseline, 4, 18 and 24 months. Costs were estimated by taking a healthcare and societal perspective. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis with 1000 replications following intention-to-treat principle was done to account for uncertainty in the analysis. RESULTS During the 2-year follow-up period, patients receiving multimodal occupational therapy gained 0.06 more QALYs than patients receiving usual care. The mean (SD) direct costs were €3227 (3546) in the intervention group and €4378 (5487) in the usual care group, mean difference €-1151 (95% CI -2564, 262). The intervention was the dominant treatment with a probability of 94.5% being cost-effective given the willingness-to-pay threshold of €27 500. CONCLUSIONS The within-trial analysis demonstrated that the multimodal occupational therapy in addition to usual care was cost-effective at 2 years in patients with CMC1 OA. TRIAL REGISTRATION NUMBER NCT01794754.
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Affiliation(s)
- Anne Therese Tveter
- Center for Treatment in Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Linn Kleven
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Nina Osteras
- Center for Treatment in Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Randi Nossum
- Department of Clinical services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Åse Klokkeide
- Department of Rheumatology, Haugesund Sanitary Association Rheumatism Hospital, Haugesund, Norway
| | - Karin Hoegh Matre
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Monika Olsen
- Department of Rheumatology, Haugesund Sanitary Association Rheumatism Hospital, Haugesund, Norway
| | - Ingvild Kjeken
- Center for Treatment in Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Jönsson T, Dell’Isola A, Lohmander LS, Wagner P, Cronström A. Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis. JAMA Netw Open 2022; 5:e2240126. [PMID: 36326763 PMCID: PMC9634502 DOI: 10.1001/jamanetworkopen.2022.40126] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities. OBJECTIVE To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention. DESIGN, SETTING, AND PARTICIPANTS This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021. EXPOSURES Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application. MAIN OUTCOMES AND MEASURES Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior. RESULTS A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome. CONCLUSIONS AND RELEVANCE This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.
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Affiliation(s)
- Therese Jönsson
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
| | - Andrea Dell’Isola
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - L. Stefan Lohmander
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anna Cronström
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Bernstein MJ. Outcomes of a digitally delivered exercise and education treatment program for low back pain after three months (Preprint). JMIR Rehabil Assist Technol 2022; 9:e38084. [PMID: 357276 PMCID: PMC9257621 DOI: 10.2196/38084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
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Implementation of telerehabilitation in Austrian outpatient physiotherapy – A qualitative study / Implementierung von Telerehabilitation in der ambulanten Physiotherapie in Österreich – Eine qualitative Studie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2022. [DOI: 10.2478/ijhp-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
New technologies, for example, telerehabilitation (TR) tools, can support physiotherapists’ work. Even though studies have demonstrated their potential, TR is not yet fully implemented in Austrian outpatient physiotherapy. As a result of the Coronavirus pandemic and the associated lockdowns, physiotherapists in Austria were confronted with the challenge of offering therapies without physical contact. This study aims to investigate opinions and experiences of physiotherapists in Austria regarding TR and its implementation in different clinical fields.
Methods
A qualitative research design with expert interviews and a focus group discussion were conducted. Data were analysed using content analysis. The categories were formed following a deductive-inductive approach.
Results
The interview partners considered opportunities for using synchronous TR in internal medicine as well as orthopaedics and traumatology, especially in later, exercise-dominated stages. In addition, using TR can be supportive for patient education. In the field of neurology, synchronous TR is viewed with some criticism, especially when used for people with severe neuropsychological disorders. Asynchronous TR is considered useful across all disciplines and could support physical therapy from the first therapy session and throughout the treatment. Important questions regarding liability, billing, or data protection still need to be clarified. Interdisciplinary approaches in TR should also be pursued to improve care.
Conclusion
The use of asynchronous TR in addition to regular physiotherapy is seen as promising in all clinical fields. In general, when implementing TR, the needs and requirements of different fields should be considered. Moreover, various framework conditions still need to be clarified for further implementation of TR.
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Gohir SA, Eek F, Kelly A, Abhishek A, Valdes AM. Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis: The iBEAT-OA Randomized Clinical Trial. JAMA Netw Open 2021; 4:e210012. [PMID: 33620447 PMCID: PMC7903254 DOI: 10.1001/jamanetworkopen.2021.0012] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Osteoarthritis is a prevalent, debilitating, and costly chronic disease for which recommended first-line treatment is underused. OBJECTIVE To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management (ie, usual care). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from October 2018 to March 2020. Participants included individuals aged 45 years or older with a diagnosis of knee osteoarthritis recruited from an existing primary care database or from social media advertisements were invited. Data were analyzed April to July 2020. INTERVENTIONS The intervention and control group conformed to first-line knee osteoarthritis treatment. For the intervention group, treatment was delivered via a smartphone application. The control group received routine self-management care. MAIN OUTCOMES AND MEASURES The primary outcome was change from baseline to 6 weeks in self-reported pain during the last 7 days, reported on a numerical rating scale (NRS; range, 0-10, with 0 indicating no pain and 10, worst pain imaginable), compared between groups. Secondary outcomes included 2 physical functioning scores, hamstring and quadriceps muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quantitative sensory testing. RESULTS Among a total of 551 participants screened for eligibility, 146 were randomized and 105 were analyzed (mean [SD] age, 66.7 [9.2] years, 71 [67.1%] women), including 48 participants in the intervention group and 57 participants in the control group. There were no significant differences in baseline characteristics between the groups. At the 6-week follow-up, the intervention group showed a greater NRS pain score reduction than the control group (between-group difference, -1.5 [95% CI, -2.2 to -0.8]; P < .001). Similarly, the intervention group had better improvements in the 30-second sit-to-stand test (between-group difference, 3.4 [95% CI, 2.2 to 4.5]; P < .001) and Timed Up-and-Go test (between-group difference, -1.8 [95% CI, -3.0 to -0.5] seconds; P = .007), as well as the WOMAC subscales for pain (between-group difference, -1.1 [95% CI, -2.0 to -0.2]; P = .02), stiffness (between-group difference, -1.0 [95% CI, -1.5 to -0.5]; P < .001), and physical function (between-group difference, -3.4 [95% CI, -6.2 to -0.7]; P = .02). The magnitude of within-group changes in pain (d = 0.83) and function outcomes (30 second sit-to-stand test d = 1.24; Timed Up-and-Go test d = 0.76) in the intervention group corresponded to medium to very strong effects. No adverse events were reported. CONCLUSIONS AND RELEVANCE These findings suggest that this internet-delivered, evidence-based, first-line osteoarthritis treatment was superior to routine self-managed usual care and could be provided without harm to people with osteoarthritis. Effect sizes observed in the intervention group corresponded to clinically important improvements. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03545048.
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Affiliation(s)
- Sameer Akram Gohir
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund University, Sweden
| | - Anthony Kelly
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Abhishek Abhishek
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ana M. Valdes
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Åkesson KE, Buchbinder R, Nordin M, Hurley MV, Overgaard S, Chang LY, Yang RS, Chan DC, Dahlberg L, Nero H, Woolf A. Advances in delivery of health care for MSK conditions. Best Pract Res Clin Rheumatol 2020; 34:101597. [DOI: 10.1016/j.berh.2020.101597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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