The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review
DOI:
https://doi.org/10.5195/ijt.2022.6524Keywords:
Cost, Efficiency, Musculoskeletal, Physiotherapy, TelerehabilitationAbstract
Introduction: While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods: Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting; intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy; and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results: Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion: Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
References
Agostini, M., Moja, L., Banzi, R., Pistotti, V., Tonin, P., Venneri, A., & Turolla, A. (2015). Telerehabilitation and recovery of motor function: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 21(4), 202-213. https://doi.org/10.1177/1357633x15572201
Aromataris E, M. Z. (2020). JBI Manual for Evidence Synthesis. https://doi.org/https://doi.org/10.46658/JBIMES-20-01
Australian Government Department of Health. (2019). 2019 Physiotherapists. https://hwd.health.gov.au/resources/publications/factsheet-alld-physiotherapists-2019.pdf
Beard, M., Orlando, J. F., & Kumar, S. (2017). Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic. Journal of Telemedicine and Telecare, 23(8), 733-739. https://doi.org/10.1177/1357633x16664851
Bennell, K. L., Lawford, B. J., Metcalf, B., Mackenzie, D., Russell, T., van den Berg, M., Finnin, K., Crowther, S., Aiken, J., Fleming, J., & Hinman, R. S. (2021). Physiotherapists and patients report positive experiences overall with telehealth during the COVID-19 pandemic: A mixed-methods study. Journal of Physiotherapy, 67(3), 201-209. https://doi.org/10.1016/j.jphys.2021.06.009
Bettger, J. P., Green, C. L., Holmes, D. N., Chokshi, A., Mather, R. C., Hoch, B. T., de Leon, A. J., Aluisio, F., Seyler, T. M., Del Gaizo, D. J., Chiavetta, J., Webb, L., Miller, V., Smith, J. M., & Peterson, E. D. (2020). Effects of virtual exercise rehabilitation in-home therapy compared with traditional care after total knee arthroplasty VERITAS, a randomized controlled trial. Journal of Bone and Joint Surgery-American Volume, 102(2), 101-109. https://doi.org/10.2106/jbjs.19.00695
Castrodad, I. M. D., Recai, T. M., Abraham, M. M., Etcheson, J. I., Mohamed, N. S., Edalatpour, A., & Delanois, R. E. (2019). Rehabilitation protocols following total knee arthroplasty: A review of study designs and outcome measures. Annals of Translational Medicine, 7, Article S255. https://doi.org/10.21037/atm.2019.08.15
Cottrell, M., Judd, P., Comans, T., Easton, P., & Chang, A. T. (2019). Comparing fly-in fly-out and telehealth models for delivering advanced-practice physiotherapy services in regional Queensland: An audit of outcomes and costs. Journal of Telemedicine and Telecare, 1357633x19858036. https://doi.org/10.1177/1357633x19858036
Cottrell, M. A., & Russell, T. G. (2020). Telehealth for musculoskeletal physiotherapy. Musculoskeletal Science & Practice, 48, 102193. https://doi.org/10.1016/j.msksp.2020.102193
Curtis, A. J., Russell, C. O. H., Stoelwinder, J. U., & McNeil, J. J. (2010). Waiting lists and elective surgery: Ordering the queue. Medical Journal of Australia, 192(4), 217. https://doi.org/10.5694/j.1326-5377.2010.tb03482.x
De Guzman, K. R., Snoswell, C. L., Caffery, L. J., & Smith, A. C. (2021). Economic evaluations of videoconference and telephone consultations in primary care: A systematic review. Journal of Telemedicine and Telecare, 1357633x211043380. https://doi.org/10.1177/1357633x211043380
de la Torre-Díez, I., López-Coronado, M., Vaca, C., Aguado, J. S., & de Castro, C. (2015). Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: A systematic review. Telemedicine and e-Health, 21(2), 81-85. https://doi.org/10.1089/tmj.2014.0053
Deeks, J. J., Dinnes, J., D'Amico, R., Sowden, A. J., Sakarovitch, C., Song, F., Petticrew, M., Altman, D. G., European Carotid Surgery Trial Collaborative, G., & International Stroke Trial Collaborative, G. (2003). Evaluating non-randomised intervention studies. Health Technology Assessment (Winchester, England), 7(27), iii.
Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology and Community Health, 52(6), 377-384. https://doi.org/10.1136/jech.52.6.377
Drummond, M. F. (2005). Methods for the economic evaluation of health care programmes (3rd ed.). Oxford University Press.
Du, S., Liu, W., Cai, S., Hu, Y., & Dong, J. (2020). The efficacy of e-health in the self-management of chronic low back pain: A meta analysis. International Journal of Nursing Studies, 106, N.PAG-N.PAG. https://doi.org/10.1016/j.ijnurstu.2019.103507
Fatoye, F., Gebrye, T., Fatoye, C., Mbada, C. E., Olaoye, M. I., Odole, A. C., & Dada, O. (2020). Clinical and cost-effectiveness analysis of telerehabilitation for people with nonspecific chronic low back pain. JMIR Mhealth Uhealth. https://doi.org/10.2196/15375
Grona, S. L., Bath, B., Busch, A., Rotter, T., Trask, C., & Harrison, E. (2018). Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review. Journal of Telemedicine and Telecare, 24(5), 341-355. https://doi.org/10.1177/1357633x17700781
Hollinghurst, S., Coast, J., Busby, J., Bishop, A., Foster, N. E., Franchini, A., Grove, S., Hall, J., Hopper, C., Kaur, S., Montgomery, A. A., & Salisbury, C. (2013). A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: Economic evaluation. BMJ Open, 3(10), e003406. https://doi.org/10.1136/bmjopen-2013-003406
Hootman, J. M., Driban, J. B., Sitler, M. R., Harris, K. P., & Cattano, N. M. (2011). Reliability and validity of three quality rating instruments for systematic reviews of observational studies. Research Synthesis Methods, 2(2), 110-118. https://doi.org/10.1002/jrsm.41
Horton, B. S., Marland, J. D., West, H. S., & Wylie, J. D. (2021). Transition to telehealth physical therapy after hip arthroscopy for femoroacetabular impingement: A pilot study with retrospective matched-cohort analysis. Orthopaedic Journal of Sports Medicine, 9(4), 2325967121997469. https://doi.org/10.1177/2325967121997469
Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustovski, F., Briggs, A. H., Mauskopf, J., & Loder, E. (2013). Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ (Clinical Research Ed.), 346, f1049. https://doi.org/10.1136/bmj.f1049
Kloek, C. J. J., van Dongen, J. M., de Bakker, D. H., Bossen, D., Dekker, J., & Veenhof, C. (2018). Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: A cluster randomized controlled trial. BMC Public Health, 18(1), 1082. https://doi.org/10.1186/s12889-018-5975-7
Mallett, R., Bakker, E., & Burton, M. (2014). Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting? Musculoskeletal Care, 12(4), 251-260. https://doi.org/10.1002/msc.1075
Malliaras, P., Merolli, M., Williams, C. M., Caneiro, J. P., Haines, T., & Barton, C. (2021). 'It's not hands-on therapy, so it's very limited': Telehealth use and views among allied health clinicians during the coronavirus pandemic. Musculoskeletal Science and Practice, 52, 102340. https://doi.org/10.1016/j.msksp.2021.102340
Mani, S., Sharma, S., Omar, B., Paungmali, A., & Joseph, L. (2017). Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: A systematic review. Journal of Telemedicine and Telecare, 23(3), 379-391. https://doi.org/10.1177/1357633x16642369
Mistry, H. (2012). Systematic review of studies of the cost-effectiveness of telemedicine and telecare. Changes in the economic evidence over twenty years. Journal of Telemedicine and Telecare, 18(1), 1-6. https://doi.org/10.1258/jtt.2011.110505
Morton, S., Barton, C. J., Rice, S., & Morrissey, D. (2014). Risk factors and successful interventions for cricket-related low back pain: A systematic review. British Journal of Sports Medicine, 48(8), 685-691. https://doi.org/10.1136/bjsports-2012-091782
O'Connor, S. R., Tully, M. A., Ryan, B., Bradley, J. M., Baxter, G. D., & McDonough, S. M. (2015). Failure of a numerical quality assessment scale to identify potential risk of bias in a systematic review: A comparison study. BMC research notes, 8, 224-224. https://doi.org/10.1186/s13104-015-1181-1
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pastora-Bernal, J. M., Martín-Valero, R., & Barón-López, F. J. (2018). Cost analysis of telerehabilitation after arthroscopic subacromial decompression. Journal of Telemedicine & Telecare, 24(8), 553-559. https://doi.org/10.1177/1357633X17723367
Pastora-Bernal, J. M., Martín-Valero, R., Barón-López, F. J., Moyano, N. G., & Estebanez-Pérez, M.-J. (2018). Telerehabilitation after arthroscopic subacromial decompression is effective and not inferior to standard practice: Preliminary results. Journal of Telemedicine & Telecare, 24(6), 428-433. https://doi.org/10.1177/1357633X17706583
Pietrzak, E., Cotea, C., Pullman, S., & Nasveld, P. (2013). Self-management and rehabilitation in osteoarthritis: Is there a place for internet-based interventions? Telemedicine and e-Health, 19(10), 800-805. https://doi.org/10.1089/tmj.2012.0288
Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), e17298. https://doi.org/10.2196/17298
Tousignant, M., Moffet, H., Nadeau, S., Mérette, C., Boissy, P., Corriveau, H., Marquis, F., Cabana, F., Ranger, P., Belzile É, L., & Dimentberg, R. (2015). Cost analysis of in-home telerehabilitation for post-knee arthroplasty. Journal of Medical Internet Research, 17(3), e83. https://doi.org/10.2196/jmir.3844
Tsou, C., Robinson, S., Boyd, J., Jamieson, A., Blakeman, R., Bosich, K., Yeung, J., Waters, S., & Hendrie, D. (2020). Effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments: A systematic review protocol. Systematic Reviews, 9(1), 82. https://doi.org/10.1186/s13643-020-01349-y
WHO. (2021, 8 February 2021). Musculoskeletal conditions. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
Zachwieja, E., Theosmy, E. G., Yacovelli, S. J., Beatty, E. W., McGrath, M. E., & Lonner, J. H. (2020). Web-Based self-directed exercise program is cost-effective compared to formal physical therapy after primary total knee arthroplasty. Journal of Arthroplasty, 35(9), 2335-2341. https://doi.org/10.1016/j.arth.2020.04.061
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