Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain.
BACKGROUND
Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered.


OBJECTIVE
To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy.


METHODS
Pragmatic, randomised controlled trial.


METHODS
Outpatient physiotherapy department and community centre.


METHODS
Sixty-four people with chronic knee pain.


METHODS
Outpatient physiotherapy compared with ESCAPE-knee pain.


RESULTS
The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.


RESULTS
Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost pound 130 per person and the healthcare utilisation costs of participants over 1 year were pound 583. The ESCAPE-knee pain programme cost pound 64 per person and the healthcare utilisation costs of participants over 1 year were pound 320.


CONCLUSIONS
ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.
Jessep
Sally A
SA
Physiotherapy Department, Sevenoaks Hospital, West Kent Primary Care Trust, Sevenoaks TN13 3PG, UK.
Walsh
Nicola E
NE
Ratcliffe
Julie
J
Hurley
Michael V
MV
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000534:rehabilitation*; D010147:Pain Measurement; D011320:Primary Health Care / Q000191:economics; D012648:Self Care / Q000191:economics*; D006113:United Kingdom