Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1—a cost-effectiveness analysis alongside a randomized controlled trial

Abstract

Objective:To analyze cost-effectiveness of Pain Exposure Physical Therapy compared to conventional treatment alongside a randomized controlled trial (NCT00817128) in patients with complex regional pain syndrome type 1, where no clinical difference was shown between the two groups in an intention-to-treat analysis.Design:Randomized controlled trial with 9 months follow-up.Setting:Patients were recruited from hospitals and general practitioners in the region around a university hospital.Subjects:A total of 56 patients, 45 (80.4%) female, were randomized. About 4 patients in the intervention and 11 patients in the conventional group switched groups. The mean (SD) age was 44.3 (16.6) years, and in 37 (66.1%) patients, the upper extremity was affected.Interventions:Patients received either Pain Exposure Physical Therapy (maximum of five sessions), or conventional treatment conforming with the Dutch multidisciplinary guideline.Main measures:For the economic evaluation difference between the groups in health-related quality of life (quality-adjusted life years (QALYs)), and the clinical outcomes Impairment level Sum Score—Restricted Version and Pain Disability was determined based on the intention-to-treat analysis as well as differences in both healthcare-related costs and travel expenses. Cost-effectiveness planes were constructed using bootstrapping to compare effects and costs.Results:No significant effects were found for QALYs (mean difference = −0.02; 95% confidence interval (CI) −0.10 to 0.04) and clinical outcomes. A cost minimization analysis showed a significant difference in costs between groups. The conventional treatment was 64% more expensive than the Pain Exposure Physical Therapy.Conclusion:This economic analysis shows that Pain Exposure Physical Therapy compared to conventional treatment is cost-effective.

Economic Evaluation in Neurological Physiotherapy: A Systematic Review

“…The pathologies covered by the largest number of studies were stroke with 21 studies (representing 48.8%), Parkinson’s disease with 6 studies (13.9%) and multiple sclerosis with 5 studies (11.6%). Only one study was published on the other eight pathologies, with the exception of complex regional pain syndrome with two studies [ 13 , 14 ]. On the other hand, two articles were found that included heterogeneous groups of patients with neurological disorders [ 15 , 16 ].…”

“…Consequently, QALY was measured in all the studies conducting cost-utility analysis [ 13 , 14 , 17 , 18 , 20 , 21 , 22 , 27 , 28 , 31 , 32 , 34 , 39 , 40 , 41 , 42 , 43 , 46 , 49 , 50 , 51 , 54 ]. Other health outcomes were used including HRQL [ 14 , 27 , 28 , 31 ], daily life activities [ 22 , 52 ] or pain [ 13 ]. In other studies, we could find variables related to the pathology in the study, including balance and gait speed [ 40 ] and number of falls avoided due to the intervention in studies for Parkinson participants [ 32 , 43 , 47 ].…”

Pain exposure physical therapy in complex regional pain syndrome: promising enough to warrant further investigation

“…2 In a more recent paper using an intention-to-treat analysis, we further showed that PEPT is less expensive and thereby more costeffective than conventional treatment. 3 In that study, patients who received PEPT had fewer visits to physical therapists and other healthcare providers.…”

Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?

“…It was shown to be a good and cost-effective treatment for patients with CRPS-1 in the upper or lower extremity. 19,[27][28][29][30] In addition to disuse, catastrophic thinking (ie, negative beliefs about pain leading to an overprotective response) is another factor that can lead to disproportionate pain and CRPS-1 after a fracture. Catastrophic thinking has often been correlated with chronic pain, disuse, and CRPS-1.…”