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Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: design of a randomised clinical trial.

van Es PP, Luijsterburg PA, Dekker J, Koopmanschap MA, Bohnen AM, Verhaar JA, Koes BW, Bierma-Zeinstra SM - BMC Musculoskelet Disord (2011)

Bottom Line: Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare) costs.Data are analysed according to the intention-to-treat principle.An incremental cost-effectiveness analysis and an incremental cost-utility analysis will also be performed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Erasmus MC, University Medical Center, Department of General Practice, PO Box 2040, 3000 CA Rotterdam, the Netherlands. p.vanes@erasmusmc.nl

ABSTRACT

Background: Osteoarthritis (OA) is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hip OA. Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare) costs. However, studies evaluating cost-effectiveness of common exercise therapy in hip OA are lacking. Therefore, this randomised controlled trial is designed to investigate the cost-effectiveness of exercise therapy in conjunction with the general practitioner's (GP) care, compared to GP care alone, for patients with hip OA.

Methods/design: Patients aged ≥ 45 years with OA of the hip, who consulted the GP during the past year for hip complaints and who comply with the American College of Rheumatology criteria, are included. Patients are randomly assigned to either exercise therapy in addition to GP care, or to GP care alone. Exercise therapy consists of (maximally) 12 treatment sessions with a physiotherapist, and home exercises. These are followed by three additional treatment sessions in the 5th, 7th and 9th month after the first treatment session. GP care consists of usual care for hip OA, such as general advice or prescribing pain medication. Primary outcomes are hip pain and hip-related activity limitations (measured with the Hip disability Osteoarthritis Outcome Score [HOOS]), direct costs, and productivity costs (measured with the PROductivity and DISease Questionnaire). These parameters are measured at baseline, at 6 weeks, and at 3, 6, 9 and 12 months follow-up. To detect a 25% clinical difference in the HOOS pain score, with a power of 80% and an alpha 5%, 210 patients are required. Data are analysed according to the intention-to-treat principle. Effectiveness is evaluated using linear regression models with repeated measurements. An incremental cost-effectiveness analysis and an incremental cost-utility analysis will also be performed.

Discussion: The results of this trial will provide insight into the cost-effectiveness of adding exercise therapy to GPs' care in the treatment of OA of the hip. This trial is registered in the Dutch trial registry http://www.trialregister.nl: trial number NTR1462.

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Related in: MedlinePlus

Clinical ACR criteria Hip.
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Related In: Results  -  Collection

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Figure 2: Clinical ACR criteria Hip.

Mentions: Participating GPs in the area of Rotterdam will invite patients with hip OA who visited them during the past year for hip complaints and who comply with the clinical American College of Rheumatology (ACR) criteria [15] for hip OA (Figure 2). After receiving a positive patient's response, researchers screen for eligibility. If eligible and patients' written informed consent is obtained, the baseline measurement is conducted (Figure 1).


Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: design of a randomised clinical trial.

van Es PP, Luijsterburg PA, Dekker J, Koopmanschap MA, Bohnen AM, Verhaar JA, Koes BW, Bierma-Zeinstra SM - BMC Musculoskelet Disord (2011)

Clinical ACR criteria Hip.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198764&req=5

Figure 2: Clinical ACR criteria Hip.
Mentions: Participating GPs in the area of Rotterdam will invite patients with hip OA who visited them during the past year for hip complaints and who comply with the clinical American College of Rheumatology (ACR) criteria [15] for hip OA (Figure 2). After receiving a positive patient's response, researchers screen for eligibility. If eligible and patients' written informed consent is obtained, the baseline measurement is conducted (Figure 1).

Bottom Line: Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare) costs.Data are analysed according to the intention-to-treat principle.An incremental cost-effectiveness analysis and an incremental cost-utility analysis will also be performed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Erasmus MC, University Medical Center, Department of General Practice, PO Box 2040, 3000 CA Rotterdam, the Netherlands. p.vanes@erasmusmc.nl

ABSTRACT

Background: Osteoarthritis (OA) is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hip OA. Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare) costs. However, studies evaluating cost-effectiveness of common exercise therapy in hip OA are lacking. Therefore, this randomised controlled trial is designed to investigate the cost-effectiveness of exercise therapy in conjunction with the general practitioner's (GP) care, compared to GP care alone, for patients with hip OA.

Methods/design: Patients aged ≥ 45 years with OA of the hip, who consulted the GP during the past year for hip complaints and who comply with the American College of Rheumatology criteria, are included. Patients are randomly assigned to either exercise therapy in addition to GP care, or to GP care alone. Exercise therapy consists of (maximally) 12 treatment sessions with a physiotherapist, and home exercises. These are followed by three additional treatment sessions in the 5th, 7th and 9th month after the first treatment session. GP care consists of usual care for hip OA, such as general advice or prescribing pain medication. Primary outcomes are hip pain and hip-related activity limitations (measured with the Hip disability Osteoarthritis Outcome Score [HOOS]), direct costs, and productivity costs (measured with the PROductivity and DISease Questionnaire). These parameters are measured at baseline, at 6 weeks, and at 3, 6, 9 and 12 months follow-up. To detect a 25% clinical difference in the HOOS pain score, with a power of 80% and an alpha 5%, 210 patients are required. Data are analysed according to the intention-to-treat principle. Effectiveness is evaluated using linear regression models with repeated measurements. An incremental cost-effectiveness analysis and an incremental cost-utility analysis will also be performed.

Discussion: The results of this trial will provide insight into the cost-effectiveness of adding exercise therapy to GPs' care in the treatment of OA of the hip. This trial is registered in the Dutch trial registry http://www.trialregister.nl: trial number NTR1462.

Show MeSH
Related in: MedlinePlus