除了运动疗法外，对于膝骨关节炎患者，手动治疗或加强治疗是否有价值：一项随机对照试验的经济学评价和 2 年随访。

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.

机构信息

Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.

出版信息

Musculoskelet Sci Pract. 2021 Dec;56:102439. doi: 10.1016/j.msksp.2021.102439. Epub 2021 Aug 5.

DOI:10.1016/j.msksp.2021.102439

PMID:34375855

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.

摘要

背景

运动疗法已被证实是治疗骨关节炎患者的有效干预手段，但目前尚不清楚是否增加手法治疗或强化治疗是否为具有成本效益的策略，可以延长获益持续时间。

目的

在 2 年随访时，调查在运动疗法中增加手法治疗和/或强化治疗的成本效益。

设计

2×2 析因随机对照试验。

方法

将膝关节骨关节炎患者随机分配（1:1:1:1）至：在 9 周内连续进行运动疗法（对照组）；在 1 年内使用强化治疗进行运动疗法；在 9 周内进行运动疗法加手法治疗；在 9 周内进行运动疗法加手法治疗和强化治疗。主要结局为从卫生系统和社会角度评估的增量成本效益，解释为增量净货币效益（INMB）。

结果

75 名参与者中，66 名（88%）在 1 年时和 40 名（53%）在 2 年时保留下来。所有三种干预措施从卫生系统和社会角度来看均具有成本效益（INMB，在 0.5×GDP/人均意愿支付（WTP）阈值下：强化治疗分别为 3278 美元（95%CI-3244 至 9800 美元）和 3904 美元（95%CI-2823 至 10632 美元）；手法治疗分别为 2941 美元（95%CI-3686 至 9568 美元）和 2618 美元（95%CI-4005 至 9241 美元）；手法治疗加强化治疗分别为 270 美元（95%CI-6139 至 6679 美元）和 404 美元（95%CI-6097 至 6905 美元）。