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
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
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DOI：
10.1016/j.joca.2018.12.004
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发表时间：
2019-03-01
影响因子：
7
通讯作者：
Braund, Rhiannon
中科院分区：
文献类型：
--
作者：
Abbott, J. H.;Wilson, R.;Braund, Rhiannon
目的：研究在2年随访时，在常规医疗护理的基础上提供个体化、监督性运动理疗和/或手动理疗的临床和成本效益。方法：符合美国风湿病学会临床诊断标准的髋关节或膝关节骨关节炎患者随机分组（1：1，隐藏，评估者设盲）分为四组：常规医疗护理;监督运动物理治疗;手动物理治疗;或运动和手动物理治疗组合。物理治疗组的参与者提供了10个50分钟的治疗，包括在4个月和13个月的助推器会议，除了常规护理。2年随访时的主要结局是从卫生系统和社会角度来看，与单独常规治疗相比，除了常规治疗外，每种物理治疗干预的增量成本效用比（ICUR）。为了解释负ICUR，我们报告了增量净效益（INB）。主要临床结果是西安大略和麦克马斯特骨关节炎指数（WOMAC）。结果：206例患者中，186例（90.3%）在2年随访时保留。运动物理疗法和手动物理疗法占主导地位的常规护理，证明节省成本;联合治疗没有。运动疗法具有最高的增量净效益（INB），在所有支付意愿方面具有统计学显著性（基础病例：新西兰社会（NZ）6，312美元，95% CI 334至12，279;卫生系统NZ 8，065美元，95% CI 136至15，994）。仅运动理疗组的临床改善上级常规护理（-28.2 WOMAC分，95% CI-49.2至-7.1）。没有严重的不良事件recorded.Conclusion：个人监督的运动疗法是具有成本效益和临床效果的，除了通常的医疗护理在2年的后续行动，并导致节省成本的卫生系统和society.Trial注册：Propionine注册与澳大利亚新西兰临床试验注册处，参考ACTRN 12608000130369。(c)2018国际骨关节炎研究学会。由爱思唯尔有限公司出版。保留所有权利。
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.