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

被引：47

作者：

Abbott, J. H. ^{[1
]}

Wilson, R. ^{[1
]}

Pinto, D. ^{[2
]}

Chapple, C. M. ^{[3
]}

Wright, A. A. ^{[4
]}

Abbott, J. Haxby ^{[5
]}

Campbell, A. John ^{[5
]}

Robertson, M. Clare ^{[5
]}

Baxter, G. David ^{[5
]}

Theis, Jean-Claude ^{[5
]}

Hansen, Paul ^{[5
]}

McKenzie, Joanne E. ^{[5
,6
]}

McNamara, Debra ^{[5
]}

Chapple, Catherine ^{[5
]}

Pinto, Daniel ^{[5
]}

Wright, Alexis ^{[5
]}

Kidd, Martin ^{[5
]}

Higgs, Chris ^{[5
]}

Smith, Jessica ^{[5
]}

Herbison, Peter ^{[5
]}

Basford, Jeffrey ^{[7
]}

Fitzgerald, G. Kelley ^{[8
]}

Flynn, Timothy ^{[9
,10
]}

Fritz, Julie ^{[11
]}

Hurley-Osing, Deidre ^{[12
]}

Whitman, Julie ^{[9
]}

Tumilty, Steve ^{[5
]}

Kennedy, Ewan ^{[5
]}

Braund, Rhiannon ^{[5
]}

机构：

[1] Univ Otago, Dunedin Sch Med, Dept Surg Sci, Ctr Musculoskeletal Outcomes Res, PO Box 913, Dunedin 9054, New Zealand

[2] Marquette Univ, Coll Hlth Sci, Program Phys Therapy, Milwaukee, WI 53233 USA

[3] Univ Otago, Sch Physiotherapy, Ctr Hlth Activ & Rehabil Res, Dunedin 9054, New Zealand

[4] High Point Univ, Dept Phys Therapy, High Point, NC USA

[5] Univ Otago, Dunedin, New Zealand

[6] Monash Univ, Clayton, Vic 3800, Australia

[7] Mayo Clin, Rochester, MI USA

[8] Univ Pittsburgh, Pittsburgh, PA USA

[9] Regis Univ, Denver, CO USA

[10] Rocky Mt Univ, Provo, UT USA

[11] Univ Utah, Salt Lake City, UT 84112 USA

[12] Univ Coll Dublin, Dublin, Ireland

来源：

OSTEOARTHRITIS AND CARTILAGE | 2019年 / 27卷 / 03期

关键词：

Osteoarthritis; Knee; Hip; Randomized controlled trial; Exercise therapy; Manual therapies; Physical therapy techniques; Musculoskeletal diseases; MANUAL THERAPY; EXERCISE THERAPY; BOOSTER SESSIONS; PHYSICAL-THERAPY; INTERVENTIONS; MULTICENTER; PROGRESSION; MANAGEMENT; VARIABLES; HEALTH;

D O I：

10.1016/j.joca.2018.12.004

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

100224 [整形外科学];

摘要：

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. (c) 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

引用

页码：424 / 434

页数：11

共 35 条

[1]

ECONOMIC EVALUATIONS OF PHYSICAL THERAPY INTERVENTIONS FOR HIP OR KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW [J].