Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand.
College of Health Sciences, Program in Physical Therapy, Marquette University, Milwaukee, WI, USA.
Osteoarthritis Cartilage. 2019 Mar;27(3):424-434. doi: 10.1016/j.joca.2018.12.004. Epub 2018 Dec 14.
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.
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).
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.
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.
Prospectively registered with the Australian NZ Clinical Trials Registry, reference ACTRN12608000130369.
在 2 年随访时，研究在常规医疗基础上增加个体监督运动疗法和/或手动物理疗法的临床和成本效益。
符合美国风湿病学会临床诊断标准的髋或膝关节骨关节炎患者按 1:1 比例（隐藏，评估者盲法）随机分为 4 组：常规医疗；监督运动疗法；手动物理疗法；或联合运动和手动物理疗法。除常规护理外，物理治疗组患者还接受了 10 次 50 分钟的治疗，包括 4 个月和 13 个月的强化治疗。2 年随访时的主要结局是从卫生系统和社会角度来看，每种物理治疗干预措施相对于单独常规护理的增量成本效用比（ICUR）。为了允许解释负的 ICUR，我们报告了增量净效益（INB）。主要临床结局是西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）。
在 206 名患者中，186 名（90.3%）在 2 年随访时保留下来。运动疗法和手动物理疗法优于常规护理，具有成本节约效果；联合治疗没有。运动疗法具有最高的增量净效益（INB），在所有意愿支付水平上均具有统计学意义（基线：社会新西兰元（NZ）$6,312，95%CI 334 至 12,279；卫生系统 NZ$8,065，95%CI 136 至 15,994）。只有运动物理疗法组的临床改善优于常规护理（-28.2 WOMAC 点，95%CI -49.2 至-7.1）。没有记录到严重的不良事件。
在 2 年随访时，与常规医疗相比，个体监督运动疗法在成本效益和临床效果方面都具有优势，并且为卫生系统和社会带来了成本节约。
前瞻性注册于澳大利亚新西兰临床试验注册中心，注册号 ACTRN12608000130369。
