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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 trial.

Publication ,  Journal Article
Pua, Y-H; Yeo, S-J; Clark, RA; Tan, BY; Haines, T; Bettger, JP; Woon, E-L; Tan, HH; Tan, JW-M; Low, J; Chew, E; Thumboo, J
Published in: Osteoarthritis Cartilage
May 2024

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.

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Published In

Osteoarthritis Cartilage

DOI

EISSN

1522-9653

Publication Date

May 2024

Volume

32

Issue

5

Start / End Page

601 / 611

Location

England

Related Subject Headings

  • Treatment Outcome
  • Physical Therapy Modalities
  • Humans
  • Hospitals
  • Cost-Benefit Analysis
  • Bayes Theorem
  • Arthroplasty, Replacement, Knee
  • Arthritis & Rheumatology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
 

Citation

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Pua, Y.-H., Yeo, S.-J., Clark, R. A., Tan, B. Y., Haines, T., Bettger, J. P., … Thumboo, J. (2024). 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 trial. Osteoarthritis Cartilage, 32(5), 601–611. https://doi.org/10.1016/j.joca.2023.11.017
Pua, Yong-Hao, Seng-Jin Yeo, Ross Allan Clark, Bryan Yijia Tan, Terry Haines, Janet Prvu Bettger, Ee-Lin Woon, et al. “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 trial.Osteoarthritis Cartilage 32, no. 5 (May 2024): 601–11. https://doi.org/10.1016/j.joca.2023.11.017.
Pua, Yong-Hao, et al. “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 trial.Osteoarthritis Cartilage, vol. 32, no. 5, May 2024, pp. 601–11. Pubmed, doi:10.1016/j.joca.2023.11.017.
Pua Y-H, Yeo S-J, Clark RA, Tan BY, Haines T, Bettger JP, Woon E-L, Tan HH, Tan JW-M, Low J, Chew E, Thumboo J. 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 trial. Osteoarthritis Cartilage. 2024 May;32(5):601–611.
Journal cover image

Published In

Osteoarthritis Cartilage

DOI

EISSN

1522-9653

Publication Date

May 2024

Volume

32

Issue

5

Start / End Page

601 / 611

Location

England

Related Subject Headings

  • Treatment Outcome
  • Physical Therapy Modalities
  • Humans
  • Hospitals
  • Cost-Benefit Analysis
  • Bayes Theorem
  • Arthroplasty, Replacement, Knee
  • Arthritis & Rheumatology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences