Cost-effectiveness of adding psychomotor therapy to a multidisciplinary rehabilitation program for chronic pain
Introduction: This study assesses the cost-effectiveness (CE) of a multidisciplinary pain rehabilitation program (treatment as usual [TAU]) with and without psychomotor therapy (PMT) for chronic pain patients.
Methods: Chronic pain patients were assigned to TAU + PMT or TAU using cluster randomization. Clinical outcomes measured were health-related quality of life (HRQOL), pain-related disability, and quality-adjusted life years (QALYs). Costs were measured from a societal perspective. Multiple imputation was used for missing data. Uncertainty surrounding incremental CE ratios was estimated using bootstrapping and presented in CE planes and CE acceptability curves.
Results: Ninety-four chronic pain patients (n = 49 TAU + PMT and n = 45 TAU) were included. There were no significant differences in HRQOL, Pain Disability Index, and QALYs between TAU + PMT and TAU. Direct costs in TAU + PMT were significantly higher than in TAU (mean difference €3327, 95% confidence interval [CI] 1329; 5506). However, total societal costs in TAU + PMT were not significantly higher than in TAU (mean difference €642, 95% CI −3323; 4373). CE analyses showed that TAU + PMT was not cost-effective in comparison with TAU.
Conclusions: Adding PMT to a multidisciplinary pain rehabilitation program is not considered cost-effective in comparison with a multidisciplinary pain rehabilitation program alone. The results of this study should be interpreted with caution because of the small sample size and high drop-out rate.
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333.
Schweikert B, Jacobi E, Seitz R, et al. Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain. J Rheumatol. 2006; 33(12):2519-26.
Lousberg R. Chronic pain, Multiaxial Diagnostics and Behavioral Mechanisms: University of Maastricht; 1994.
Picavet HSJ, Schouten JSAG. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study. Pain. 2003;102:167-178.
Becker A. Health economics of interdisciplinary rehabilitation for chronic pain: does it support or invalidate the outcomes research of these programs? Curr Pain Headache Rep. 2012; 16(2):127-132.
Lambeek LC, van Tulder MW, Swinkels ICS, Koppes LLJ, Anema JR, van Mechelen W. The trend in total cost of back pain in the Netherlands in the period 2002 to 2007. Spine. 2011;36(13):1050-1058.
Turk DC. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain. 2002;18(6): 355-365.
Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006;7(11):779-793.
Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
Hauser W, Bernardy K, Arnold B, Offenbacher M, Schiltenwolf M. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum. 2009;61(2):216-224.
Grahn EBM, Ekdahl CS, Borgquist L. Effects of a multidisciplinary rehabilitation programme on health-related quality of life in patients with prolonged musculoskeletal disorders: a 6-month follow-up of a prospective controlled study. Disabil Rehabil. 1998;20(8):285-297.
Haugli L, Steen E, Lærum E, Nygard R, Finset A. Learning to have less pain – is it possible? A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain. Patient Educ Couns. 2001;45(2):111-118.
Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8(2):163-190.
Landsman-Dijkstra JJA, van Wijck R, Groothoff JW. The long-term lasting effectiveness on self-efficacy, attribution style, expression of emotions and quality of life of a body awareness program for chronic a-specific psychosomatic symptoms. Patient Educ Couns. 2006;60:66-79.
Malmgren-Olsson E, Armelius B, Armelius K. A comparative outcome study of body awareness therapy, feldenkrais, and conventional physiotherapy for patients with non-specific musculoskeletal disorders: changes in psychological symptoms, pain, and self-image. Physiother Theory Practice. 2001;17(2):77-96.
Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomized, controlled trial of breath therapy for patients with chronic low-back pain. Altern Ther Health Med. 2005;11(4):44-52.
Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disabil Rehabil. 2005;27(12):725-728.
Probst M, Knapen J, Poot G, Vancampfort D. Psychomotor therapy and psychiatry: what’s in the name? Open Compl Med J. 2010;2:105-113.
Steen E, Haugli L. From pain to self-awareness – a qualitative analysis of the significance of group participation for persons with chronic musculoskeletal pain. Patient Educ Counsel. 2001; 42(1):35-46.
Haugli L, Steen E, Laerum E, Finset A, Nygaard R. Agency orientation and chronic musculoskeletal pain: effects of a group learning program based on the personal construct theory. Clin J Pain. 2000;16(4):281-289.
Landsman-Dijkstra JJA, van Wijck R, Groothoff JW, Rispens P. The short-term effects of a body awareness program: better self-management of health problems for individuals with chronic a-specific psychosomatic symptoms. Patient Educ Counsel. 2004;55:155-167.
Van der Maas LC, Köke A, Pont M, et al. Improving the multidisciplinary treatment of chronic pain by stimulating body awareness: a cluster-randomized trial. Clin J Pain. 2015 Jul;31(7): 660-669.
Efron B. Forcing a sequential experiment to be balanced. Biometrika. 1971;58(3):403-417.
Van der Meijden, van der Kolk H, Bosscher R. Psychomotorische Therapie voor mensen met chronische pijn; een methodisch raamwerk. Zwolle: Christelijke Hogeschool Windesheim, 2007.
Van der Zee KI, Sanderman R, Heyink JW, de Haes H. Psychometric qualities of the RAND 36-item health survey 1.0: a multidimensional measure of general health status. Int J Behav Med. 1996;3(2):104-122.
Pollard CA. Preliminary validity study of the Pain Disability Index. Percept Mot Skills. 1984;59(3):974.
EuroQoL Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199-208.
Lamers LM, Stalmeier PF, McDonnell J, Krabbe PFM, Busschbach JJ. Kwaliteit van leven meten in economische evaluaties: het Nederlands EQ-5D-tarief. Nederlands Tijdschrift voor Geneeskunde. 2005;149:1574-1578.
Hakkaart-van Roijen L, Tan SS, Bouwmans CAM. Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. College voor zorgverzekeringen; 2011.
Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.
Willan AR, Briggs AH, Hoch JS. Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ. 2004;13(5):461-475.
Efron B. Missing data, imputation, and the bootstrap. J Am Stat Assoc. 1994;89(426):463-75.
Black WC. The CE plane – a graphic representation of cost-effectiveness. Med Decis Making. 1990;10(3):212-214.
Fenwick E, O’Brien BJ, Briggs A. Cost-effectiveness acceptability curves – facts, fallacies and frequently asked questions. Health Econ. 2004;13(5):405-415.
Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajarvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev. 2013;8:CD001822.
Briggs A. Economic evaluation and clinical trials: size matters – the need for greater power in cost analyses poses an ethical dilemma. Br Med J. 2000;321(7273):1362-1363.
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