Abstract
BackgroundExercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders (WRULD).AimsTo study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints, both from health care and societal perspective.MethodsProspective randomized trial including cost-effectiveness analysis; one year follow-up. Participants: Eighty-eight screen-workers with early non-specific WRULD; six drop-outs. Interventions: A ten week postural exercise program versus regular physiotherapy. Outcome measures: Effectiveness measures: Pain: visual analogous scale (VAS), self-perceived WRULD (yes/no). Functional outcome: Disabilities of Arm, Shoulder and Hand- Dutch Language Version (DASH-DLV). Quality of life outcome: EQ-5D.Economic measures: health care costs including patient and family costs and productivity costs resulting in societal costs. Cost-effectiveness measures: health care costs and societal costs related to the effectiveness measures. Outcome measures were assessed at baseline; three, six and twelve months after baseline.ResultsAt baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs. No significant differences between the groups concerning effectiveness at one year follow-up were found. Effectiveness scores slightly improved over time. After one year 55% of participants were free of complaints. After one year the postural exercise group had higher mean total health care costs, but lower productivity costs compared to the physiotherapy group. Mean societal costs after one year (therefore) were in favor of postural exercise therapy [- €622; 95% CI -2087; +590)]. After one year, only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs, postural exercise therapy had a probability of over 80% to be cost-effective over a wide range of cost-effectiveness ceiling ratios; however based on a marginal QALY-difference of 0.1 over a 12 month time frame.ConclusionAlthough our trial failed to find significant differences in VAS, QALYs and ICERs based on VAS and QALYs at one-year follow-up, CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy; however further research is required.Trial registrationISRCTN 15872455
Highlights
Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders (WRULD)
After one year the postural exercise group had higher mean total health care costs, but lower productivity costs compared to the physiotherapy group
Mean societal costs after one year () were in favor of postural exercise therapy [- €622; 95% CI -2087; +590)]
Summary
Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders (WRULD). The prevalence of Work-Related Upper Limb Disorders (WRULD) in the Dutch working population is estimated about 19-30% [1]. Due to expectations of increasing intensity of computer screen-work, the prevalence of WRULD among screen-workers is expected to increase even more [2,3]. WRULD can result in decreased productivity, increased medical consumption and increased costs. A recent study estimates the total yearly costs due to specific and non-specific WRULD in the Netherlands at about 2.1 billion Euros, consisting of medical costs, costs due to decreased productivity, absenteeism related to WRULD and disability pensions [4]. Of all WRULD complaints, it is estimated that specific disorders are responsible for about 13-37% of them.
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