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DOS Kongressen 2016 ·
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Supervised neuromuscular exercise prior to hip
and knee replacement: 12-month clinical effect
and cost-utility analysis alongside a randomised
controlled trial
Fernandes Linda, Roos Ewa, Overgaard Søren, Villadsen Allan, Søgaard Rikke
Dept. of Rehabilitation, Odense University Hospital; Inst. of Sport Science and
Clinical Biomechanics, University of Southern Denmark; Dept. of Orthopedics
and Traumatology, Odense University Hospital; Dept. of Orthopedics and
Traumatology, Odense University Hospital; Dept. of Clinical Medicine, Aarhus
University
Background:
Few studies on cost-effectiveness of exercise intervention in os-
teoarthritis
Purpose / Aim of Study:
To analyse 12-month clinical effect and cost-utility
of supervised neuromuscular exercise prior to total hip replacement (THR) and
total knee replacement (TKR).
Materials and Methods:
The study was conducted alongside a randomised
controlled trial including 165 patients randomised to standard THR or TKR with
or without a twice weekly, 8-week preoperative supervised neuromuscular ex-
ercise program (Clinical Trials registration no.: NCT01003756). Clinical effect
was measured with Hip disability and Osteoarthritis Outcome Score (HOOS)
and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted
life years (QALYs) were based on EQ-5D-3L and Danish preference weights.
Resource use was extracted from national registries and valued using standard
tariffs (2012-EUR). Incremental net benefit was analysed to estimate the prob-
ability for the intervention being cost effective for a range of threshold values.
A health care sector perspective was applied
Findings / Results:
HOOS/KOOS quality of life [8.25 (95% CI, 0.42 to 16.10)]
and QALYs [0.04 (95% CI, 0.01 to 0.07)] were statistically significantly im-
proved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales.
Despite including an intervention cost of €326 per patient, there was no dif-
ference in total cost between groups [€132 (95% CI -3942 to 3679)]. At a
threshold of €40,000, preoperative exercise was found to be cost effective at
84% probability
Conclusions:
Preoperative supervised neuromuscular exercise for 8 weeks was
found to be cost-effective in patients scheduled for THR and TKA surgery at
conventional thresholds for willingness to pay. One-year clinical effects were
small to moderate and favoured the intervention group, but only statistically
significat for quality of life measures
No conflicts of interest reported
144.