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Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial.

Authors :
FERNÁNDEZ-DE-LAS-PEÑAS, CÉSAR
ORTEGA-SANTIAGO, RICARDO
SALOM-MORENO, JAIME
ARIAS-BURÍA, JOSÉ L.
FAHANDEZH-SADDI DÍAZ, HOMID
CLELAND, JOSHUA A.
PAREJA, JUAN A.
Source :
Journal of Orthopaedic & Sports Physical Therapy; Feb2019, Vol. 49 Issue 2, p55-63, 9p
Publication Year :
2019

Abstract

* BACKGROUND: Carpal tunnel syndrome (CTS) results in substantial societal costs and can be treated either by nonsurgical or surgical approaches. * OBJECTIVE: To evaluate differences in cost-effectiveness of manual physical therapy versus surgery in women with CTS. * METHODS: In this randomized clinical trial, 120 women with a clinical and an electromyographic diagnosis of CTS were randomized through concealed allocation to either manual physical therapy or surgery. Interventions consisted of 3 sessions of manual physical therapy, including desensitization maneuvers of the central nervous system, or decompression/release of the carpal tunnel. Societal costs and health-related quality of life (estimated by the European Quality of Life-5 Dimensions [EQ-5D] scale) over 1 year were used to generate incremental cost per quality-adjusted life year ratios for each treatment. * RESULTS: The analysis was possible for 118 patients (98%). Incremental quality-adjusted life years showed greater cost-effectiveness in favor of manual physical therapy (difference, 0.135; 95% confidence interval: 0.134,0.136). Manual therapy was significantly less costly than surgery (mean difference in cost per patient, €2576; P<.001). Patients in the surgical group received a greater number of other treatments and made more visits to medical doctors than those receiving manual physical therapy (P = .02). Absenteeism from paid work was significantly higher in the surgery group (P<.001). The major contributors to societal costs were the treatment protocol (surgery versus manual therapy mean difference, €106980) and absenteeism from paid work (surgery versus manual physical therapy mean difference, €42224). * CONCLUSION: Manual physical therapy, including desensitization maneuvers of the central nervous system, has been found to be equally effective but less costly (ie, more cost-effective) than surgery for women with CTS. From a cost-benefit perspective, the proposed CTS manual physical therapy intervention can be considered. * LEVEL OF EVIDENCE: Economic and decision analyses, level 1b. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
01906011
Volume :
49
Issue :
2
Database :
Supplemental Index
Journal :
Journal of Orthopaedic & Sports Physical Therapy
Publication Type :
Academic Journal
Accession number :
134847870
Full Text :
https://doi.org/10.2519/jospt.2019.8483