Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial

Hurley, M., Walsh, N., Mitchell, H., Nicholas, J. and Patel, A. (2012) 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). pp. 238-247. ISSN 2151-4659

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Publisher's URL: http://dx.doi.org/10.1002/acr.20642

Abstract

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.

Item Type:Article
Uncontrolled Keywords:rehabilitation, chronic knee pain
ID Code:16494
Deposited By: Dr N. Walsh
Deposited On:02 Feb 2012 13:58
Last Modified:06 Apr 2014 18:13

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