Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization

Farag, Inez; Howard, Kirsten; Hayes, Alison; Ferreira, Manuela L; Lord, Stephen R.; Close, Jacqueline C.T.; Vogler, Constance; Dean, Catherine M.; Cumming, Robert G.; Sherrington, Catherine

doi:10.1016/j.jamda.2015.01.075

Cited by 25 publications

(24 citation statements)

References 30 publications

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“…These interventions need at least one exercise trainer and venue fees for on‐site training programmes. Home‐exercise programme has been shown to be cost‐effective for mobility outcomes . Further economic evaluation are needed for our interventions.…”

Section: Discussionmentioning

confidence: 85%

Integrated care for geriatric frailty and sarcopenia: a randomized control trial

Chan

Tsou

Chang

et al. 2016

J cachexia sarcopenia muscle

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BackgroundExercise, nutrition, and psychological interventions may all have positive impacts on frailty and sarcopenia. However, it is not known whether an integrated care programme with all three components can be beneficial and the intensity of such programme is also not certain. In this study, we aim to determine the effectiveness of two levels of integrated care on frailty and sarcopenia.MethodsA randomized control trial was conducted at two community hospitals in Taiwan. Older adults (65–79 years of age, N = 289) who scored ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty (CHS_PCF) were enrolled in the trial. Low‐level care (LLC) participants received a 2 h education course on frailty, sarcopenia, coping strategy, nutrition, and demonstration of study exercise programme. Educational multimedia material was distributed as reference for home practice with bi‐monthly telephone follow‐ups on adherences. High‐level care (HLC) participants, in addition to LLC instructions, received six sessions of on‐site problem solving therapy and 48 exercise sessions within 6 months. Brief nutrition consultation was also provided during the exercise sessions. Primary outcome was improvement of the CHS_PCF by at least one category (from pre‐frail to robust, or from frail to pre‐frail or robust) from baseline. Secondary outcomes included changes of individual frailty, and sarcopenia indicators. Assessments were done at 3, 6, and 12 months by trained research assistants blinded to randomization status. Intention‐to‐treat analysis was applied.ResultsMean age was 71.6 ± 4.3 years, with 53% females. For the entire cohort, improvement of primary outcome was 35% at 3 months, increased to 40% at 6 months, and remained stable at 39% at 12 months. Improvement rates were similar in both groups. Compared with the LLC group, HLC participants had greater improvements in the following indices: energy expenditure of walking, 5 m walking time, dominant hand grip strength, timed‐up‐and‐go‐test, and one‐leg‐stand time — mainly at 6 and 12 month assessments.ConclusionsThe 6 month integrated care improved frailty and sarcopenia status among community‐dwelling elders, with high‐intensity training yielding greater improvements. Low‐level care could be promoted as a basic intervention, while HLC could be reserved for those at high risk and with high motivation.

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Section: Discussionmentioning

confidence: 85%

Integrated care for geriatric frailty and sarcopenia: a randomized control trial

Chan

Tsou

Chang

et al. 2016

J cachexia sarcopenia muscle

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“…Nine economic evaluations of exercise programs were identified . The ICERs of CUAs ranged from $30,013 to $80,860 per QALY.…”

Section: Resultsmentioning

confidence: 99%

Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review

Olij

Ophuis

Polinder

et al. 2018

J American Geriatrics Society

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OBJECTIVES: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. DESIGN: Systematic review of economic evaluations on falls prevention programs. SETTING: Studies (N=31) of community-dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before , medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately twothirds of all reported incremental cost-effectiveness ratios (ICERs) with quality-adjusted life-years (QALYs) as outcome were below the willingness-to-pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. CONCLUSION: The majority of the reported ICERs indicated that falls prevention programs were cost-effective, but methodological differences between studies hampered direct comparison of the cost-effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost-effective. Home assessment programs (ICERs < $40,000/QALY) were the most costeffective type of program for community-dwelling older adults, and medication adjustment programs (ICERs < $13,000/ QALY) were the most cost-effective type of program for older adults living in a residential care facility.

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“…For higher functioning patients, it may be useful to track periods were the patient is able to attend group therapy, or perform self-management strategies, home exercise programmes 33 and tele-rehabilitation. 34 Appropriate use of the PhysDB-FCP could help inform decision making on these strategies along with guidance for appropriate treatment or referral, while also meeting future challenges of an increased population with chronic disease, without compromising patient care.…”

Section: Findings To Datementioning

confidence: 99%

Cohort profile: Design and implementation of the Danish Physiotherapy Research Database for patients receiving primary care with chronic disease

Næss‐Schmidt

Andersen²,

Christiansen

et al. 2020

BMJ Open

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PurposeFree of charge physiotherapy (FCP) is free physiotherapy provided by the Danish government for patients with a range of chronic diseases. To date, the population has not been described in depth making evaluation and decision making difficult. The purpose of this study was to (1) describe the development and the content of a novel clinical physiotherapy database for FCP (PhysDB-FCP) and (2) present the cohort profile based on the data collected.ParticipantsNinety-nine clinics (17 460 FCP patients) were invited to participate in the development process from 2018 to 2019. Eleven clinics consented (2780 FCP patients) and 534 patients performed the physiotherapy assessment using the PhysDB-FCP tool, with 393/534 completing the patient survey.Findings to dateThe content of the PhysDB-FCP was developed through an iterative process involving consensus between clinical and research workgroups. Prior to using the tool all consenting sites received training to use/administer the tool. All data were collected/stored using the PhysDB-FCP. Items finally chosen for the PhysDB-FCP included demographic information, questions about health status and daily functioning, functional tests, treatment plan and validated questionnaires. The initial patient cohort composed of 63.4% women with main diagnoses of multiple sclerosis (22.7%) and Parkinson’s disease (17.0%). The ability to perform personal/instrumental activities of daily living and functional ability varied widely. Other non-physiotherapy related issues were identified in numerous patients (ie, 34.9% of patients were at risk of depression) and multidisciplinary interventional approaches could be considered.Future plansThe current study has provided a comprehensive description of patients receiving FCP, using data collected from the novel PhysDB-FCP. Collected information can be used to facilitate microlevel to macrolevel programme evaluation and decisions. Although the PhysDB-FCP is promising, the tool requires optimisation before it is implemented regionally and/or nationally.

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Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization

Cited by 25 publications

References 30 publications

Integrated care for geriatric frailty and sarcopenia: a randomized control trial

Integrated care for geriatric frailty and sarcopenia: a randomized control trial

Economic Evaluations of Falls Prevention Programs for Older Adults: A Systematic Review

Cohort profile: Design and implementation of the Danish Physiotherapy Research Database for patients receiving primary care with chronic disease

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