The Clinical and Cost-Effectiveness of Telerehabilitation for People With Nonspecific Chronic Low Back Pain: Randomized Controlled Trial

Francis Fatoye, Tadesse Gebrye, Clara Fatoye, Chidozie E Mbada, Mistura I Olaoye, Adesola C Odole, Olumide Dada, Francis Fatoye, Tadesse Gebrye, Clara Fatoye, Chidozie E Mbada, Mistura I Olaoye, Adesola C Odole, Olumide Dada

Abstract

Background: Telerehabilitation can facilitate multidisciplinary management for people with nonspecific chronic low back pain (NCLBP). It provides health care access to individuals who are physically and economically disadvantaged.

Objective: This study aimed to evaluate the clinical and cost-effectiveness of telerehabilitation compared with a clinic-based intervention for people with NCLBP in Nigeria.

Methods: A cost-utility analysis alongside a randomized controlled trial from a health care perspective was conducted. Patients with NCLBP were assigned to either telerehabilitation-based McKenzie therapy (TBMT) or clinic-based McKenzie therapy (CBMT). Interventions were carried out 3 times weekly for a period of 8 weeks. Patients' level of disability was measured using the Oswestry Disability Index (ODI) at baseline, week 4, and week 8. To estimate the health-related quality of life of the patients, the ODI was mapped to the short-form six dimensions instrument to generate quality-adjusted life years (QALYs). Health care resource use and costs were assessed based on the McKenzie extension protocol in Nigeria in 2019. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. Bootstrapping was conducted to generate the point estimate of the incremental cost-effectiveness ratio (ICER).

Results: A total of 47 patients (TBMT, n=21 and CBMT, n=26), with a mean age of 47 (SD 11.6) years for telerehabilitation and 50 (SD 10.7) years for the clinic-based intervention, participated in this study. The mean cost estimates of TBMT and CBMT interventions per person were 22,200 naira (US $61.7) and 38,200 naira (US $106), respectively. QALY gained was 0.085 for TBMT and 0.084 for CBMT. The TBMT arm was associated with an additional 0.001 QALY (95% CI 0.001 to 0.002) per participant compared with the CBMT arm. Thus, the ICER showed that the TBMT arm was less costly and more effective than the CBMT arm.

Conclusions: The findings of the study suggested that telerehabilitation for people with NCLBP was cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions is needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the long term from the patient and societal perspective.

Keywords: cost-utility analysis; low back pain; mobile phone; quality-adjusted life years; telerehabilitation.

Conflict of interest statement

Conflicts of Interest: None declared.

©Francis Fatoye, Tadesse Gebrye, Clara Fatoye, Chidozie E Mbada, Mistura I Olaoye, Adesola C Odole, Olumide Dada. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 24.06.2020.

Figures

Figure 1
Figure 1
Flowchart of included patients. CBMT: clinic-based McKenzie therapy; TBMT: telerehabilitation-based McKenzie therapy.
Figure 2
Figure 2
The incremental cost-effectiveness plane for a plot of 1000 bootstrap incremental costs and effects resample means. The blue circles are the plots of 1000 bootstraps incremental costs and effects resample means.

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