Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain

Jessep, Sally A.; Hurley, Michael V.; Walsh, Nicola; Ratcliffe, Julie

Abstract

Background: Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered. Objectives: To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy. Design: Pragmatic, randomised controlled trial. Setting: Outpatient physiotherapy department and community centre. Participants: Sixty-four people with chronic knee pain. Interventions: Outpatient physiotherapy compared with ESCAPE-knee pain. Outcomes: The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences. Results: Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost £130 per person and the healthcare utilisation costs of participants over 1 year were £583. The ESCAPE-knee pain programme cost £64 per person and the healthcare utilisation costs of participants over 1 year were £320. Conclusions: ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective. Clinical Trial Registration No.: ISRCTN63848242. Crown Copyright © 2009.

Citation

Hurley, M. V., Jessep, S. A., Walsh, N., & Ratcliffe, J. (2009). Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain. Physiotherapy, 95(2), 94-102. https://doi.org/10.1016/j.physio.2009.01.005

• Journal Article Type: Article
• Publication Date: Jun 1, 2009
• Deposit Date: Dec 13, 2010
• Journal: Physiotherapy
• Electronic ISSN: 1230-8323
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 95
• Issue: 2
• Pages: 94-102
• DOI: https://doi.org/10.1016/j.physio.2009.01.005
• Keywords: knee pain, exercise-based rehabilitation, physiotherapy, functioning, healthcare costs
• Public URL: https://uwe-repository.worktribe.com/output/1003463
• Publisher URL: http://dx.doi.org/10.1016/j.physio.2009.01.005
• Contract Date: Nov 15, 2016