Hurley, M., Walsh , N., Mitchell , H., Nicholas, J. and Patel, A.
Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial.
Arthritis Care and Research, 64 (2).
Publisher's URL: http://dx.doi.org/10.1002/acr.20642
Objective. Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term
benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months)
clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-
Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain).
Methods. In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54
primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The
primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]
function), with a clinically meaningful improvement in physical function defined as a >15% change from baseline.
Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness.
Results. Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean
difference in WOMAC function �5.5; 95% confidence interval [95% CI] �7.8, �3.2). These improvements declined over
time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function
(difference in WOMAC function �2.8; 95% CI �5.3, �0.2); lower community-based health care costs (£�47; 95% CI £�94,
£�7), medication costs (£�16; 95% CI £�29, £�3), and total health and social care costs (£�1,118; 95% CI £�2,566,
£�221); and a high probability (80–100%) of being cost effective.
Conclusion. Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program.
ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs.
|Uncontrolled Keywords:||rehabilitation, chronic knee pain|
Dr N. Walsh
|Deposited On:||02 Feb 2012 13:58|
|Last Modified:||09 Nov 2013 09:27|
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