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Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial

OBJECTIVES: To assess the effectiveness and cost-utility of a multifaceted eHealth strategy compared to usual care in improving patients’ back pain beliefs, and in decreasing disability and absenteeism. DESIGN: Stepped-wedge cluster randomised trial with parallel economic evaluation. SETTING: Dutch...

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Detalles Bibliográficos
Autores principales: Suman, Arnela, Schaafsma, Frederieke G., van Dongen, Johanna M., Elders, Petra J.M., Buchbinder, Rachelle, van Tulder, Maurits W., Anema, Johannes R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924789/
https://www.ncbi.nlm.nih.gov/pubmed/31811006
http://dx.doi.org/10.1136/bmjopen-2019-030879
Descripción
Sumario:OBJECTIVES: To assess the effectiveness and cost-utility of a multifaceted eHealth strategy compared to usual care in improving patients’ back pain beliefs, and in decreasing disability and absenteeism. DESIGN: Stepped-wedge cluster randomised trial with parallel economic evaluation. SETTING: Dutch primary healthcare. PARTICIPANTS: Patients diagnosed with non-specific low back pain by their general practitioner or physiotherapist. Patients with serious comorbidities or confirmed pregnancy were excluded. 779 patients were randomised into intervention group (n=331, 59% female; 60.4% completed study) or control group (n=448, 57% female; 77.5% completed study). INTERVENTIONS: The intervention consisted of a multifaceted eHealth strategy that included a (mobile) website, digital monthly newsletters, and social media platforms. The website provided information about back pain, practical advice (eg, on self-management), working and returning to work with back pain, exercise tips, and short video messages from healthcare providers and patients providing information and tips. The control consisted of a digital patient information letter. Patients and outcome assessors were blinded to group allocation. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was back pain beliefs. Secondary outcome measures were disability and absenteeism, and for the preplanned economic evaluation quality of life and societal costs were measured. RESULTS: There were no between-group differences in back pain beliefs, disability, or absenteeism. Mean intervention costs were €70— and the societal cost difference was €535—in favour of the intervention group, but no significant cost savings were found. The incremental cost-effectiveness ratio indicated that the intervention dominated usual care and the probability of cost-effectiveness was 0.85 on a willingness-to-pay of €10.000/quality adjusted life year (QALY). CONCLUSIONS: A multifaceted eHealth strategy was not effective in improving patients’ back pain beliefs or in decreasing disability and absenteeism, but showed promising cost-utility results based on QALYs. TRIAL REGISTRATION NUMBER: NTR4329.