BACKGROUND:There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though, information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery.
METHODS:The study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise 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 probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied.
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 improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of €326 per patient, there was no difference 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.
CONCLUSION:Preoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group, but only statistically significant for quality of life measures.
TRIAL REGISTRATION:ClinicalTrials.gov ( NCT01003756 ) October 28, 2009.
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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.].
【在髋关节和膝关节置换之前进行有监督的神经肌肉锻炼：12个月的临床效果和成本效用分析以及一项随机对照试验。】
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DOI：10.1186/s12891-016-1369-0文章类型：杂志文章
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背景：有迹象表明，术前短期锻炼有利于减轻疼痛并改善全髋关节置换（THR）和全膝关节置换（TKR）手术后的日常生活活动。但是，需要从进行更长时间的随访研究和在THR和TKR之前对运动进行经济评估的信息。这项研究的目的是分析在THR和TKR手术之前进行有监督的神经肌肉锻炼的12个月临床效果和成本效用。
方法：该研究与一项随机对照试验一起进行，该试验包括165名计划在丹麦农村地区的医院中接受标准THR或TKR治疗的患者。将患者随机分为进行或不进行8周术前有监督的神经肌肉锻炼程序（临床试验注册号：NCT01003756）的替代手术。用髋关节残疾和骨关节炎结果评分（HOOS）以及膝关节损伤和骨关节炎结果评分（KOOS）来衡量临床效果。质量调整生命年（QALYs）基于EQ-5D-3L和丹麦偏好权重。资源使用是从国家注册管理机构中提取的，并使用标准关税（2012-EUR）进行估值。对增量净收益进行了分析，以估计对于一系列阈值而言，干预措施具有成本效益的可能性。应用了卫生保健部门的观点。
结果：HOOS / KOOS生活质量[8.25（95％CI，0.42至16.10）]和QALYs [0.04（95％CI，0.01至0.07）]在统计学上有显着改善。 HOOS / KOOS分量表的效果大小范围在0.09-0.59之间。尽管包括每位患者326欧元的干预费用，但各组之间的总费用没有差异[132欧元（95％CI -3942至3679）]。在术前锻炼的成本阈值为40,000欧元时，发现该锻炼的成本效益为84％。
结论：对于计划进行THR和TKR手术的患者，在常规的支付意愿阈值下，术前进行有监督的8周神经肌肉锻炼是合算的。一年的临床效果小到中等，偏爱干预组，但对生活质量的测量仅具有统计学意义。
试用注册：ClinicalTrials.gov（NCT01003756），2009年10月28日。
方法：该研究与一项随机对照试验一起进行，该试验包括165名计划在丹麦农村地区的医院中接受标准THR或TKR治疗的患者。将患者随机分为进行或不进行8周术前有监督的神经肌肉锻炼程序（临床试验注册号：NCT01003756）的替代手术。用髋关节残疾和骨关节炎结果评分（HOOS）以及膝关节损伤和骨关节炎结果评分（KOOS）来衡量临床效果。质量调整生命年（QALYs）基于EQ-5D-3L和丹麦偏好权重。资源使用是从国家注册管理机构中提取的，并使用标准关税（2012-EUR）进行估值。对增量净收益进行了分析，以估计对于一系列阈值而言，干预措施具有成本效益的可能性。应用了卫生保健部门的观点。
结果：HOOS / KOOS生活质量[8.25（95％CI，0.42至16.10）]和QALYs [0.04（95％CI，0.01至0.07）]在统计学上有显着改善。 HOOS / KOOS分量表的效果大小范围在0.09-0.59之间。尽管包括每位患者326欧元的干预费用，但各组之间的总费用没有差异[132欧元（95％CI -3942至3679）]。在术前锻炼的成本阈值为40,000欧元时，发现该锻炼的成本效益为84％。
结论：对于计划进行THR和TKR手术的患者，在常规的支付意愿阈值下，术前进行有监督的8周神经肌肉锻炼是合算的。一年的临床效果小到中等，偏爱干预组，但对生活质量的测量仅具有统计学意义。
试用注册：ClinicalTrials.gov（NCT01003756），2009年10月28日。
