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Cost-effectiveness ...
Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial
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Landen Ludvigsson, Maria (författare)
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Peolsson, Anneli (författare)
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Peterson, Gunnel (författare)
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visa fler...
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Dedering, Åsa (författare)
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Johansson, Gun (författare)
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Bernfort, Lars, 1967- (författare)
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visa färre...
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(utgivare)
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(utgivare)
- LIPPINCOTT WILLIAMS & WILKINS, 2017
- 2017
- Engelska.
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Ingår i: Medicine (Baltimore, Md.). - 0025-7974. ; 96:25
Abstract
Ämnesord
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- Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.
Ämnesord
- Medical and Health Sciences (hsv)
- Health Sciences (hsv)
- Physiotherapy (hsv)
- Medicin och hälsovetenskap (hsv)
- Hälsovetenskaper (hsv)
- Sjukgymnastik (hsv)
Nyckelord
- chronic; cost; cost-effectiveness; exercise; physiotherapy; rehabilitation; whiplash
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