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

Arnela Suman, Frederieke G Schaafsma, Johanna M van Dongen, Petra J M Elders, Rachelle Buchbinder, Maurits W van Tulder, Johannes R Anema

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)e030879
JournalBMJ Open
Volume9
Issue number12
DOIs
Publication statusPublished - 5 Dec 2019

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Telemedicine
Back Pain
Low Back Pain
Cost-Benefit Analysis
Absenteeism
Costs and Cost Analysis
Quality-Adjusted Life Years
Outcome Assessment (Health Care)
Social Media
Cost Savings
Physical Therapists
Self Care
Health Personnel
General Practitioners
Comorbidity
Primary Health Care
Quality of Life
Exercise
Pregnancy
Control Groups

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Cite this

Suman, Arnela ; Schaafsma, Frederieke G ; van Dongen, Johanna M ; Elders, Petra J M ; Buchbinder, Rachelle ; van Tulder, Maurits W ; Anema, Johannes R. / 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. In: BMJ Open. 2019 ; Vol. 9, No. 12. pp. e030879.
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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. / Suman, Arnela; Schaafsma, Frederieke G; van Dongen, Johanna M; Elders, Petra J M; Buchbinder, Rachelle; van Tulder, Maurits W; Anema, Johannes R.

In: BMJ Open, Vol. 9, No. 12, 05.12.2019, p. e030879.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain

T2 - a cluster randomised trial

AU - Suman, Arnela

AU - Schaafsma, Frederieke G

AU - van Dongen, Johanna M

AU - Elders, Petra J M

AU - Buchbinder, Rachelle

AU - van Tulder, Maurits W

AU - Anema, Johannes R

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/12/5

Y1 - 2019/12/5

N2 - 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.

AB - 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.

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JO - BMJ Open

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SN - 2044-6055

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