Journal article
Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial1
Osteoarthritis and Cartilage, Vol.32(5), pp.601-611
2024
Abstract
Objective:
To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA).
Design:
In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points).
Results:
In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, −0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, −0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, −0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, −S$227; 95%CrI, −112 to −330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs.
Conclusions:
In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.
Details
- Title
- Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial1
- Authors
- Yong-Hao Pua (Corresponding Author) - Singapore General HospitalSeng-Jin Yeo (Author) - Singapore General HospitalRoss Allan Clark (Author) - University of the Sunshine Coast, Queensland, School of Health - Public HealthBryan Yijia Tan (Author) - Nanyang Technological UniversityTerry Haines (Author) - Monash UniversityJanet Prvu Bettger (Author) - Temple UniversityEe-Lin Woon (Author) - Singapore General HospitalHong-Han Tan (Author) - Singapore General HospitalJohn Wei-Ming Tan (Author) - Singapore General HospitalJuanita Low (Author) - Singapore General HospitalEleanor Chew (Author) - Singapore General HospitalJulian Thumboo (Author) - Singapore General Hospital
- Publication details
- Osteoarthritis and Cartilage, Vol.32(5), pp.601-611
- Publisher
- Elsevier Ltd
- Date published
- 2024
- DOI
- 10.1016/j.joca.2023.11.017
- ISSN
- 1522-9653
- Grant note
- This study was funded by Singapore Ministry of Health's National Medical Research Council (NMRC/TA/0004/2018).
- Organisation Unit
- School of Health - Public Health; Healthy Ageing Research Cluster
- Language
- English
- Record Identifier
- 99982895302621
- Output Type
- Journal article
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