Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions

Miyamoto, Gisela Cristiane; Ben, Ângela Jornada; Bosmans, Judith E.; Tulder, Maurits W. van; Lin, Chung‐Wei Christine; Cabral, Cristina Maria Nunes; Dongen, Johanna M. van

doi:10.1016/j.bjpt.2021.06.011

Cited by 17 publications

(25 citation statements)

References 110 publications

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“…In addition, a limitation of the economic evaluation was the generalization of data to different countries. The literature (Ginsberg, 2013; Miyamoto et al, 2021) suggests that generalizing cost‐utility results from different countries is not indicated due to the differences in incidence rates of the diseases, valuation costs, time horizon, perspectives (considering healthcare system and societal) and willingness‐to‐pay thresholds. However, a favourable point was that our cost‐effectiveness data provided economic health information about developing countries, which is scarce.…”

Section: Discussionmentioning

confidence: 99%

“…The cost-effectiveness analysis was performed using the impact of fibromyalgia as a disease-specific outcome (Miyamoto et al, 2021), and the cost-utility analysis was performed using quality-adjusted life years (QALYs) from the EQ-5D. The health states of the patients measured by the EQ-5D were converted to utility values using the Brazilian tariff (Menezes et al, 2015), and the linear interpolation between the utility values at baseline and follow-ups was used to calculate QALYs.…”

Section: Discussionmentioning

confidence: 99%

“…Incremental cost-effectiveness ratios were calculated by the adjusted difference between intervention costs divided by the adjusted difference between intervention effects. Bias-corrected and accelerated bootstrapping techniques with 5000 replications were used to estimate uncertainty surrounding the cost differences and the incremental cost-effectiveness ratios (Miyamoto et al, 2021). The bootstrapped estimates for incremental cost-effectiveness ratios were graphically represented in cost-effectiveness planes (Black, 1990).…”

Section: Discussionmentioning

confidence: 99%

“…In the multiple imputation analysis, 10 complete datasets were created (loss‐of‐efficiency <5%). Pooled estimates were calculated according to Rubin's rules (Miyamoto et al, 2018; Miyamoto et al, 2021; Sterne et al, 2009).…”

Section: Methodsmentioning

confidence: 99%

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Is Pilates more effective and cost‐effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation

Miyamoto

Franco

Salvador

et al. 2022

European Journal of Pain

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Background The aim of this study was to assess the effectiveness and cost‐effectiveness of Pilates versus aerobic exercises in the treatment of patients with fibromyalgia syndrome from a societal perspective. Methods This two‐arm randomized controlled trial with blinded assessor and economic evaluation included 98 patients diagnosed with fibromyalgia syndrome using the American College of Rheumatology 2010 criteria, aged between 20 and 75 years, and pain intensity ≥3 points in the Pain Numerical Rating Scale. Patients were randomly allocated into the aerobic or Pilates group. Treatment was performed twice a week for 8 weeks. The primary outcome was the impact of fibromyalgia measured 8 weeks after randomization. Cost‐effectiveness and cost‐utility analyses were conducted for the impact of fibromyalgia and quality‐adjusted life‐years (QALYs), respectively, with a 12‐month time horizon. Results There was no difference between the groups for the impact of fibromyalgia (MD: 6.5 points; 95% CI: −1.8 to 14.9). The incremental cost‐effectiveness ratio showed that 1‐point increase in the impact of fibromyalgia was on average associated with a societal cost of £56 for the Pilates group compared to the aerobic group. The cost‐utility analysis showed that the Pilates group had a 0.71 probability of being cost‐effective at a willingness‐to‐pay of £30,000 per QALY gained. Conclusion There was no significant difference between groups for the impact of fibromyalgia. Pilates was not cost‐effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be the preferred option of treatment considering QALYs, although it depends on the willingness‐to‐pay threshold. Significance Pilates showed to be a safe and effective alternative for the treatment of patients with fibromyalgia syndrome. Pilates presented similar results for the impact of fibromyalgia and superior results for pain relief compared to aerobic exercises, a highly recommended intervention for the treatment of fibromyalgia syndrome. Pilates was not cost‐effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be a cost‐effective intervention for QALYs, depending on the decision‐maker's willingness‐to‐pay threshold.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Is Pilates more effective and cost‐effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation

Miyamoto

Franco

Salvador

et al. 2022

European Journal of Pain

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“…The lost productivity costs included absenteeism from paid work. Absenteeism was estimated by asking patients the number of hours not worked owing to chronic musculoskeletal pain and valued according to the Human Capital Approach using sex-specific price weights [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program

Fioratti¹,

Miyamoto²,

Fandim³

et al. 2022

JMIR Form Res

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Background Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. Objective This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. Methods The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients’ perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. Results In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US $278.30 per patient in the intervention group and US $141.52 per patient in the control group. No adverse events were reported during the intervention period. Conclusions We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users’ implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. Trial Registration ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439

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What is the Status Quo of Patient-Centred Physiotherapy Management of People with Headache within a Biopsychosocial Model? – A Narrative Review

Mingels,

Granitzer,

Luedtke

et al. 2024

Curr Pain Headache Rep

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Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions

Cited by 17 publications

References 110 publications

Is Pilates more effective and cost‐effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation

Is Pilates more effective and cost‐effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation

Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program

What is the Status Quo of Patient-Centred Physiotherapy Management of People with Headache within a Biopsychosocial Model? – A Narrative Review

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