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

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 SelfManagement 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.

Osteoarthritis 2012 year in review: rehabilitation and outcomes

“…This was supported by a large RCT published by Hurley et al 3 , which reported that exercise and selfmanagement for 6 weeks only had a high probability (80e100%) of being cost-effective at 30 months. Four hundred and eighteen patients with chronic knee pain met the inclusion criteria and were assigned to either the exercise and self-management group or the control group (usual care).…”

Modern Non-Pharmacological and Non-Surgical Treatments for Hip Pain

“…Whilst it is a very recent development, early study of the brace looks promising: it effectively appears to decrease levels of internal abduction, which is a major contributor to the compressive forces through the joint. This may lead, as it did immediately in some of the study patients, to reduced pain whilst wearing the device during walking [53,54]. There is, of course, the need for more in-depth study of the characteristics and effects of the brace, though it may become an attractive management plan to delay the need for THR.…”

Exercise, Gait Retraining, Footwear and Insoles for Knee Osteoarthritis

“…A recent RCT has contributed to current knowledge in this area. In a pragmatic cluster RCT in 418 people with chronic knee pain [11], long-term clinical and cost benefits were found 30 months after the completion of a rehabilitation program that combined self-management and exercise. The authors reported improvements in symptoms, as well as reductions in community-based health care costs, medication costs, and total health and social care costs, compared to usual care.…”