A systematic review of economic models for cost effectiveness of physiotherapy interventions following total knee and hip replacement

Fatoye, Francis; Gebrye, Tadesse; Fatoye, C.; Mbada, Chidozie Emmanuel

doi:10.1016/j.physio.2022.01.002

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…The physiotherapy treatment consists of passive and active mobilizations immediately after the surgery, cryotherapy, and exercises that promote the functionality and strength of the knee joint [13]. However, sometimes the classical physiotherapy approach, involving passive and analytic exercises that do not favor the participation of the patient in their rehabilitation, is considered monotonous and low motivating by the patients; and their high socio-economic cost does not allow all patients to continue with the same treatment [14]. On the other hand, in recent years, virtual reality and telerehabilitation have been postulated as effective therapeutic tools in the management of different musculoskeletal disorders such as low back pain [15], shoulder pain [16], spondyloarthros [17] and cervical post-surgery rehabilitation [18], among others.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Virtual Reality-Based Early Postoperative Rehabilitation after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

et al. 2023

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Virtual reality-based rehabilitation (VRBR) is being used in rehabilitation after total knee arthroplasty (TKA). This meta-analysis assesses the effect of immediate and/or maintained effect of VRBR (alone or in combination with conventional therapy (CT) in TKA recovery. To perform this meta-analysis, we searched in PubMed, SCOPUS, WOS, CINAHL, and PEDro until 5 February 2023. We included randomized controlled trials that assessed the effect of VRBR in improving knee pain and function, dynamic balance, range of motion (ROM), and strength, among others, after TKA. The pooled effect was calculated with Cohen’s standardized mean difference (SMD) with a 95% confidence interval (95% CI). Twelve studies, providing data from 997 participants (69.9 ± 8.1 years old), were included. At post-immediate assessment, VRBR is effective in improving knee pain (SMD = −0.36; 95% CI −0.56 to −0.17), knee function (SMD = −0.51; 95% CI −0.75 to −0.27), dynamic balance (SMD = −0.59; 95% CI −1.02 to −0.15), knee flexion ROM (SMD = 0.4; 95% CI 0.17 to 0.62), and extension strength (SMD = 0.43; 95% CI 0.19 to 0.68). Our findings showed that immersive and non-immersive VRBR is effective to be used after TKA, and the effect on knee pain and function may be maintained over 3 or 6 months. A high level of satisfaction and adherence to VRBR was reported.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of Virtual Reality-Based Early Postoperative Rehabilitation after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

et al. 2023

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“…Using a mobile application might be ideal to standardize the follow-up of PT interventions after TKA and provide direct quantitative feedback to the patients, which increases their motivation [7]. Usually, exercise adherence decreases over time [16,23], while in our study, it stayed high until the end of the rehabilitation program. It is likely that the closed feedback provided by the data and the human intervention provided to the patients by the physical therapists daily through the app increased their motivation [7,24].…”

Section: Discussionmentioning

confidence: 78%

“…A cost–consequence analysis approach was chosen as no comparative analysis was possible given the absence of a control group. Cost–consequence analysis is considered a logical first step towards a formal economic evaluation [ 16 , 17 , 18 ]. Direct costs were analyzed separately from outcomes.…”

Section: Methodsmentioning

confidence: 99%

Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study

Lebleu¹,

Pauwels²,

Anract

et al. 2023

JPM

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Rehabilitation for total knee replacement (TKA) often involves in-person therapy sessions, which can be time consuming and costly. Digital rehabilitation has the potential to address these limitations, but most of these systems offer standardized protocols without considering the patient’s pain, participation, and speed of recovery. Furthermore, most digital systems lack human support in case of need. The aim of this study was to investigate the engagement, safety, and clinical effectiveness of a personalized and adaptative app-based human-supported digital monitoring and rehabilitation program. In this prospective multi-center longitudinal cohort study, 127 patients were included. Undesired events were managed through a smart alert system. Doctors were triggered when there was a suspicion of problems. The drop-out rate, complications and readmissions, PROMS, and satisfaction were collected through the app. There was only 2% readmission. Doctor actions through the platform potentially avoided 57 consultations (85% of alerts). The adherence to the program was 77%, and 89% of the patients would recommend the use of the program. Personalized human-backed-up digital solutions can help to improve the rehabilitation journey of patients after TKA, lower healthcare-related costs by lowering the complication and readmission rate, and improve patient reported outcomes.

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“…Total hip arthroplasty (THA) is an important surgical method for the treatment of end-stage hip diseases such as hip dysplasia, femoral head necrosis, and hip osteoarthritis. It aims to relieve pain and improve function and quality of life [1][2]. Studies have shown [3] that about 400,000 cases of total hip arthroplasty are performed in China every year, and it is estimated that the utilization rate of THA in China will gradually increase in the future.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

Cao

Saad

Pan

et al. 2022

Preprint

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Objective To compare the efficacy of low molecular weight heparin (LMWH), fondaparinux sodium (FPX), and rivaroxaban after total hip arthroplasty (THA) under Enhanced Recovery After Surgery (ERAS). Method The clinical data of patients who underwent primary THA due to hip joint disease in Ningxia Medical University General Hospital from October 2020 to June 2022 were retrospectively collected and analyzed. According to different anticoagulant methods, patients were divided into LMWH group (42 cases), FPX group (24 cases), and Rivaroxaban group (39 cases). Detect and record changes of blood coagulation-related factors, D-dimer, platelet (PLT) changes, blood routine, blood loss, lower limb vein thrombosis (DVT), pulmonary embolism, and allogeneic blood transfusion in the three groups perioperatively. Result There was no statistical significance in the comparison of coagulation indexes before the operation among the three groups (P > 0.05), but there was statistical significance in the comparison of PT and INR levels at 3 days after the operation (P < 0.05). There was a statistically significant difference between the Hb before operation and the Hct 3 days after operation in the three groups (P < 0.05). The postoperative drainage volume and overt blood loss of the three groups were statistically significant (P < 0.05), but there were no significant differences in intraoperative blood loss, hidden blood loss, and total blood loss (P > 0.05). There was no significant difference in VAS score, blood transfusion rate, and DVT incidence rate among the three groups before and 3 days after surgery (P > 0.05), and the treatment cost ratio of patients in LMWH group was lower than that of FPX group and Rivaroxaban group, the difference was statistically significant (P < 0.05). Conclusion Based on the ERAS concept, the use of LMWH, FPX, and Rivaroxaban after THA can effectively and safely prevent the occurrence of VTE and has no significant difference in postoperative pain, perioperative blood loss, and coagulation function. However, Rivaroxaban can be taken orally directly and has more advantages in pharmacological effects, while LMWH is cheaper and more economical.

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A systematic review of economic models for cost effectiveness of physiotherapy interventions following total knee and hip replacement

Cited by 9 publications

References 19 publications

Effectiveness of Virtual Reality-Based Early Postoperative Rehabilitation after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Effectiveness of Virtual Reality-Based Early Postoperative Rehabilitation after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Digital Rehabilitation after Knee Arthroplasty: A Multi-Center Prospective Longitudinal Cohort Study

Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

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