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

doi:10.1136/bmjopen-2019-030879

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 journal › Article › Academic › peer-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 language	English
Article number	e030879
Journal	BMJ Open
Volume	9
Issue number	12
DOIs	https://doi.org/10.1136/bmjopen-2019-030879
Publication status	Published - 5 Dec 2019
Externally published	Yes

Keywords

eHealth
health economics
low back pain
public health
randomised controlled trial

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10.1136/bmjopen-2019-030879

Cite this

@article{6172e8e3bc6a4e4fb11e4ea53ef9871d,

title = "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",

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.",

keywords = "eHealth, health economics, low back pain, public health, randomised controlled trial",

author = "Arnela Suman and Schaafsma, {Frederieke G} and {van Dongen}, {Johanna M} and Elders, {Petra J M} and Rachelle Buchbinder and {van Tulder}, {Maurits W} and Anema, {Johannes R}",

note = "{\textcopyright} 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.",

year = "2019",

month = dec,

day = "5",

doi = "10.1136/bmjopen-2019-030879",

language = "English",

volume = "9",

journal = "BMJ Open",

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

Research output: Contribution to journal › Article › Academic › peer-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

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.

KW - eHealth

KW - health economics

KW - low back pain

KW - public health

KW - randomised controlled trial

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DO - 10.1136/bmjopen-2019-030879

M3 - Article

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SN - 2044-6055

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JF - BMJ Open

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ER -

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

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Keywords

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