Authors' objectives:

The study aimed to establish the relative effectiveness and cost of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme.

Authors' results and conclusions: Analysis involved the use of a longitudinal linear model analysis of covariance. Patients from the supplemented group demonstrated significantly greater improvement in locomotor function and decrease in pain while walking at all follow-ups. Pooled estimates of effect were 2.9 seconds [95% confidence interval (CI) 1.8 to 4.0] for locomotor function and 14.9mm (95% CI 11.7 to 18.1) for walking pain, representing between-group differences of 12% and 27%, respectively. The supplemented group also demonstrated smaller but significant improvements in balance, strength, WOMAC score, and the physical function and pain dimensions of the Short Form-36 (p < 0.05). However, not all of these improvements were maintained over the 12-month follow-up period. There was no evidence that compliance with the home exercise programme was different or that total costs or mean QALY gains were significantly different between the groups. However, costs were slightly lower and QALY gains slightly higher in the group with the supplementary class-based programme. Thus, for most reasonable values of a decisionmakers willingness to pay for an additional QALY, the addition of the class-based programme is likely to be cost-effective. There is considerable uncertainty around this estimate and a probability of approximately 3035% that the intervention is not cost-effective.

Authors' recommendations: The supplementation of a home-based exercise programme with a class-based exercise programme led to superior improvement in the supplemented group. These differential improvements were still evident at review 12 months after treatment had ceased. The additional cost of the supplemented group was offset by reductions in resource use elsewhere in the system. Compliance with the home exercise programme did not differ between the groups.

Authors' methods: Randomised controlled trial, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/999

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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