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Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain
Jessep SA, Walsh NE, Ratcliffe J, Hurley MV
Physiotherapy 2009 Jun;95(2):94-102
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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. OBJECTIVES: To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy. DESIGN: Pragmatic, randomised controlled trial. SETTING: Outpatient physiotherapy department and community centre. PARTICIPANTS: Sixty-four people with chronic knee pain. INTERVENTIONS: Outpatient physiotherapy compared with ESCAPE-knee pain. OUTCOMES: 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 Great British Pounds 130 per person and the healthcare utilisation costs of participants over 1 year were Great British Pounds 583. The ESCAPE-knee pain programme cost Great British Pounds 64 per person and the healthcare utilisation costs of participants over 1 year were Great British Pounds 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. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN63848242.

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