Cost-effectiveness of Postural Exercise Therapy Versus Physiotherapy in Computer Screen-workers with Early Non-specific Work-related Upper Limb Disorders (WRULD); a Randomized Controlled Trial

Overview

Journal Trials

Publisher Biomed Central

Specialties General Medicine
Pharmacology

Date 2009 Nov 20

PMID 19922603

Citations 6

Authors

Marjon D van Eijsden

Sylvia A Gerhards

Rob A de Bie

Johan L Severens

Affiliations

Soon will be listed here.

Abstract

Background: Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders (WRULD).

Aims: To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints, both from health care and societal perspective.

Methods: Prospective randomized trial including cost-effectiveness analysis; one year follow-up.

Participants: Eighty-eight screen-workers with early non-specific WRULD; six drop-outs.

Interventions: A ten week postural exercise program versus regular physiotherapy.

Outcome Measures: Effectiveness measures: Pain: visual analogous scale (VAS), self-perceived WRULD (yes/no). Functional outcome: Disabilities of Arm, Shoulder and Hand- Dutch Language Version (DASH-DLV). Quality of life outcome: EQ-5D.Economic measures: health care costs including patient and family costs and productivity costs resulting in societal costs. Cost-effectiveness measures: health care costs and societal costs related to the effectiveness measures. OUTCOME MEASURES were assessed at baseline; three, six and twelve months after baseline.

Results: At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs. No significant differences between the groups concerning effectiveness at one year follow-up were found. Effectiveness scores slightly improved over time. After one year 55% of participants were free of complaints. After one year the postural exercise group had higher mean total health care costs, but lower productivity costs compared to the physiotherapy group. Mean societal costs after one year (therefore) were in favor of postural exercise therapy [- euro622; 95% CI -2087; +590)]. After one year, only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs, postural exercise therapy had a probability of over 80% to be cost-effective over a wide range of cost-effectiveness ceiling ratios; however based on a marginal QALY-difference of 0.1 over a 12 month time frame.

Conclusion: Although our trial failed to find significant differences in VAS, QALYs and ICERs based on VAS and QALYs at one-year follow-up, CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy; however further research is required.

Trial Registration: ISRCTN 15872455.

Citing Articles

Changes in health-related quality of life (EQ-5D) dimensions associated with community-based musculoskeletal physiotherapy: a multi-centre analysis.

Caplan N, Robson H, Robson A, Kelly M, Wilkes G Qual Life Res. 2018; 27(9):2373-2382.

PMID: 29948600 PMC: 6133001. DOI: 10.1007/s11136-018-1883-7.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions.

Sultan-Taieb H, Parent-Lamarche A, Gaillard A, Stock S, Nicolakakis N, Hong Q BMC Public Health. 2017; 17(1):935.

PMID: 29216849 PMC: 5721617. DOI: 10.1186/s12889-017-4935-y.

Associations between community-based physiotherapy for musculoskeletal injury and health related quality of life (EQ-5D): a multi-centre retrospective analysis.

Caplan N, Robson H, Robson A, Barry G, Wilkes G Health Qual Life Outcomes. 2017; 15(1):212.

PMID: 29065895 PMC: 5655980. DOI: 10.1186/s12955-017-0789-3.

Estimating productivity costs using the friction cost approach in practice: a systematic review.

Kigozi J, Jowett S, Lewis M, Barton P, Coast J Eur J Health Econ. 2014; 17(1):31-44.

PMID: 25387561 DOI: 10.1007/s10198-014-0652-y.

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians.

Chan C, Ackermann B Front Psychol. 2014; 5:706.

PMID: 25071671 PMC: 4086404. DOI: 10.3389/fpsyg.2014.00706.

References

Smidt N, de Vet H, Bouter L, Dekker J, Arendzen J, de Bie R . Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. Aust J Physiother. 2005; 51(2):71-85. DOI: 10.1016/s0004-9514(05)70036-2. View

Koopmanschap M, Burdorf A, Jacob K, Meerding W, Brouwer W, Severens H . Measuring productivity changes in economic evaluation: setting the research agenda. Pharmacoeconomics. 2005; 23(1):47-54. DOI: 10.2165/00019053-200523010-00004. View

Briggs A, OBrien B . The death of cost-minimization analysis?. Health Econ. 2001; 10(2):179-84. DOI: 10.1002/hec.584. View

Sluiter J, Rest K, Frings-Dresen M . Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scand J Work Environ Health. 2001; 27 Suppl 1:1-102. View

Verhagen A, Karels C, Bierma-Zeinstra S, Burdorf L, Feleus A, Dahaghin S . Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database Syst Rev. 2006; (3):CD003471. DOI: 10.1002/14651858.CD003471.pub3. View

Oostenbrink J, Al M . The analysis of incomplete cost data due to dropout. Health Econ. 2005; 14(8):763-76. DOI: 10.1002/hec.966. View

Staal J, de Bie R, Hendriks E . Aetiology and management of work-related upper extremity disorders. Best Pract Res Clin Rheumatol. 2007; 21(1):123-33. DOI: 10.1016/j.berh.2006.09.001. View

Vitale M, Vitale M, Zivin J, Braman J, Bigliani L, Flatow E . Rotator cuff repair: an analysis of utility scores and cost-effectiveness. J Shoulder Elbow Surg. 2007; 16(2):181-7. DOI: 10.1016/j.jse.2006.06.013. View

Meijer E, Sluiter J, Heyma A, Sadiraj K, Frings-Dresen M . Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up. Int Arch Occup Environ Health. 2006; 79(8):654-64. DOI: 10.1007/s00420-006-0098-3. View

10.

Verhagen A, Karels C, Bierma-Zeinstra S, Feleus A, Dahaghin S, Burdorf A . Exercise proves effective in a systematic review of work-related complaints of the arm, neck, or shoulder. J Clin Epidemiol. 2007; 60(2):110-7. DOI: 10.1016/j.jclinepi.2006.05.006. View

11.

Picavet H, Hoeymans N . Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis. 2004; 63(6):723-9. PMC: 1755044. DOI: 10.1136/ard.2003.010769. View

12.

Oostenbrink J, Koopmanschap M, Rutten F . Standardisation of costs: the Dutch Manual for Costing in economic evaluations. Pharmacoeconomics. 2002; 20(7):443-54. DOI: 10.2165/00019053-200220070-00002. View

13.

Koopmanschap M, Rutten F, van Ineveld B, van Roijen L . The friction cost method for measuring indirect costs of disease. J Health Econ. 1995; 14(2):171-89. DOI: 10.1016/0167-6296(94)00044-5. View

14.

Fenwick E, Claxton K, Sculpher M . Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ. 2001; 10(8):779-87. DOI: 10.1002/hec.635. View

15.

Jensen M, McFarland C . Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993; 55(2):195-203. DOI: 10.1016/0304-3959(93)90148-I. View

16.

Veehof M, Sleegers E, van Veldhoven N, Schuurman A, van Meeteren N . Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV). J Hand Ther. 2002; 15(4):347-54. DOI: 10.1016/s0894-1130(02)80006-0. View

17.

IJmker S, Huysmans M, Blatter B, van der Beek A, van Mechelen W, Bongers P . Should office workers spend fewer hours at their computer? A systematic review of the literature. Occup Environ Med. 2006; 64(4):211-22. PMC: 2078461. DOI: 10.1136/oem.2006.026468. View

18.

Bernaards C, Ariens G, Hildebrandt V . The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers. BMC Musculoskelet Disord. 2006; 7:80. PMC: 1634849. DOI: 10.1186/1471-2474-7-80. View

19.

van Eijsden-Besseling M, Peeters F, Reijnen J, de Bie R . Perfectionism and coping strategies as risk factors for the development of non-specific work-related upper limb disorders (WRULD). Occup Med (Lond). 2004; 54(2):122-7. DOI: 10.1093/occmed/kqh003. View

20.

van Eijsden-Besseling M, Staal J, van Attekum A, de Bie R, van den Heuvel W . No difference between postural exercises and strength and fitness exercises for early, non-specific, work-related upper limb disorders in visual display unit workers: a randomised trial. Aust J Physiother. 2008; 54(2):95-101. DOI: 10.1016/s0004-9514(08)70042-4. View