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Evaluating the Cost Effectiveness of Tele-Rehabilitation: A Systematic Review of Randomized Clinical Trials
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Abstract
Introduction: Despite the epidemic of Covid 19, the current budget constraints of governments do not allow to increase the budget of conventional rehabilitation programs. As a result, there is a growing need for cost-effective alternative strategies such as tele-rehabilitation. Therefore, the purpose of this study was a systematic review of randomized clinical trial studies to evaluate the cost-effectiveness of tele-rehabilitation.
Materials and Method: A systematic review, without time limit, was searched by searching for keywords in the title, abstract and keywords of studies in the authoritative scientific databases Embase, Web of Science, Scopus, PubMed on November 24, 2021. Randomized and controlled trial studies that used the Tele-rehabilitation approach as an intervention in the study and evaluated it in terms of cost-effectiveness were considered as inclusion criteria. Eligibility criteria were screened independently by two researchers. In order to evaluate the quality of the input studies to this study, the JBI quality evaluation checklist for randomized controlled trials was used. The same checklist was used to extract the data. The data elements in this checklist included the title of the publication, year of publication, country, number of participants, duration of intervention, technology-based approach, study population, study objectives and main findings of the study.
Results: A total of 11 articles with inclusion criteria were included in the study. There was no significant bias in the studies and all studies had the quality of inclusion in our study. The Tele-rehabilitation approaches and health conditions evaluated in the studies were largely different. In 45% of the studies, Tele-rehabilitation interventions reported a significant improvement in the outcomes and clinical effects in the Tele-rehabilitation group versus the control group (face-to-face visit). In 64% of the studies, Tele-rehabilitation interventions were more cost effective than traditional rehabilitation interventions. However, in 36% of the studies, no significant difference was observed in the amount of money spent between the control and intervention groups. In addition, in 4 of the studies, no significant improvement in quality in the adjusted years was reported.
Conclusion: The evidence from this study shows that Tele-rehabilitation services and care for the general public are more cost effective than face-to-face rehabilitation services. It is suggested that future studies to maximize the potential of tele-rehabilitation focus on improving patients' access to rehabilitation services and removing barriers to tele-rehabilitation.
References
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021; 396(10267): 2006-17. PMID: 33275908 DOI: 10.1016/S0140-6736(20)32340-0
Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA. 2000; 284(16): 2061-9. PMID: 11042754 DOI: 10.1001/jama.284.16.2061
World Health Organization & World Bank. World report on disability 2011 [Internet]. 2011 [cited: 15 Apr 2022]. Available from: https://apps.who.int/iris/handle/10665/44575
Darzi AJ, Officer A, Abualghaib O, Akl EA. Stakeholders’ perceptions of rehabilitation services for individuals living with disability: A survey study. Health Qual Life Outcomes. 2016; 14: 2. PMID: 26746197 DOI: 10.1186/s12955-016-0406-x
World Health Organization. WHO global disability action plan 2014-2021: Better health for all people with disability [Internet]. 2015 [cited: 1 Apr 2022]. Available from: https://www.who.int/publications/i/item/who-global-disability-action-plan-2014-2021
Bendixen RM, Levy CE, Olive ES, Kobb RF, Mann WC. Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes. Telemed J E Health. 2009; 15(1): 31-8. PMID: 19199845 DOI: 10.1089/tmj.2008.0046
World Health Organization. Rehabilitation in health systems: Guide for action [Internet]. 2019 [cited: 12 Apr 2022]. Available from: https://www.who.int/publications/i/item/9789241515986
World Health Organization. Rehabilitation [Internet]. 2020 [cited: 11 Apr 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation.
Mair R, Feeley D. A national telehealth and telecare delivery plan for Scotland to 2016: Driving improvement, integration and innovation [Internet]. 2012 [cited: 1 Apr 2022]. Available from: https://www.gov.scot/publications/national-telehealth-telecare-delivery-plan-scotland-2016-driving-improvement-integration-innovation/
Shenoy MP, Shenoy PD. Identifying the challenges and cost-effectiveness of telerehabilitation: A narrative review. Journal of Clinical & Diagnostic Research. 2018; 12(12): 1-4.
Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998; 18(2 Suppl): S68-80. PMID: 9566468 DOI: 10.1177/0272989X98018002S09
Hofer F, Achelrod D, Stargardt T. Cost-utility analysis of telemonitoring interventions for patients with chronic obstructive pulmonary disease (COPD) in Germany. Appl Health Econ Health Policy. 2016; 14(6): 691-701. PMID: 27475635 DOI: 10.1007/s40258-016-0267-9
Fatoye F, Gebrye T, Fatoye C, Mbada CE, Olaoye MI, Odole AC, et al. The clinical and cost-effectiveness of telerehabilitation for people with nonspecific chronic low back pain: Randomized controlled trial. JMIR Mhealth Uhealth. 2020; 8(6): e15375. PMID: 32357128 DOI: 10.2196/15375
Dansky KH, Palmer L, Shea D, Bowles KH. Cost analysis of telehomecare. Telemed J E Health. 2001; 7(3): 225-32. PMID: 11564358 DOI: 10.1089/153056201316970920
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7): e1000100. PMID: 19621070 DOI: 10.1371/journal.pmed.1000100
Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097. PMID: 19621072 DOI: 10.1371/journal.pmed.1000097
Joanna Briggs Institute. Critical appraisal checklist for randomized controlled trials [Internet]. 2018 [cited: 12 Apr 2022]. Available from: http://joannabriggs. org/research/criticalappraisaltools. html
Haesum LK, Soerensen N, Dinesen B, Nielsen C, Grann O, Hejlesen O, et al. Cost-utility analysis of a telerehabilitation program: A case study of COPD patients. Telemed J E Health. 2012; 18(9): 688-92. PMID: 23020647 DOI: 10.1089/tmj.2011.0250
Hwang R, Morris NR, Mandrusiak A, Bruning J, Peters R, Korczyk D, et al. Cost-utility analysis of home-based telerehabilitation compared with centre-based rehabilitation in patients with heart failure. Heart Lung Circ. 2019; 28(12): 1795-803. PMID: 30528811 DOI: 10.1016/j.hlc.2018.11.010
Frederix I, Hansen D, Coninx K, Vandervoort P, Vandijck D, Hens N, et al. Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: A cost-effectiveness analysis. Eur J Prev Cardiol. 2016; 23(7): 674-82. PMID: 26289723 DOI: 10.1177/2047487315602257
Lloréns R, Noé E, Colomer C, Alcañiz M. Effectiveness, usability, and cost-benefit of a virtual reality–based telerehabilitation program for balance recovery after stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2015; 96(3): 418-25. PMID: 25448245 DOI: 10.1016/j.apmr.2014.10.019
Maddison R, Rawstorn JC, Stewart RA, Benatar J, Whittaker R, Rolleston A, et al. Effects and costs of real-time cardiac telerehabilitation: Randomised controlled non-inferiority trial. Heart. 2019; 105(2): 122-9. PMID: 30150328 DOI: 10.1136/heartjnl-2018-313189
Niewada M, Tabor B, Piotrowicz E, Piotrowicz R, Opolski G, Banach M, et al. Cost-effectiveness of telerehabilitation in patients with heart failure in Poland: An analysis based on the results of telerehabilitation in the heart failure patients (TELEREH-HF) randomized clinical trial. Kardiol Pol. 2021; 79(5): 510-6. PMID: 34125923 DOI: 10.33963/KP.15885
Nelson M, Russell T, Crossley K, Bourke M, McPhail S. Cost-effectiveness of telerehabilitation versus traditional care after total hip replacement: A trial-based economic evaluation. J Telemed Telecare. 2021; 27(6): 359-66. PMID: 31530065 DOI: 10.1177/1357633X19869796
Longacre CF, Nyman JA, Visscher SL, Borah BJ, Cheville AL. Cost‐effectiveness of the collaborative care to preserve performance in cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers. Cancer Med. 2020; 9(8): 2723-31. PMID: 32090502 DOI: 10.1002/cam4.2837
Kidholm K, Rasmussen MK, Andreasen JJ, Hansen J, Nielsen G, Spindler H, et al. Cost-utility analysis of a cardiac telerehabilitation program: the teledialog project. Telemed J E Health. 2016; 22(7): 553-63. PMID: 26713491 DOI: 10.1089/tmj.2015.0194
Koehler F, Winkler S, Schieber M, Sechtem U, Stangl K, Böhm M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: The telemedical interventional monitoring in heart failure study. Circulation. 2011; 123(17): 1873-80. PMID: 21444883 DOI: 10.1161/CIRCULATIONAHA.111.018473
Neubeck L, Freedman S, Briffa T, Bauman A, Redfern J. Four-year follow-up of the choice of health options in prevention of cardiovascular events randomized controlled trial. Eur J Cardiovasc Prev Rehabil. 2011; 18(2): 278-86. PMID: 20606594 DOI: 10.1097/HJR.0b013e32833cca66
Körtke H, Stromeyer H, Zittermann A, Buhr N, Zimmermann E, Wienecke E, et al. New east–westfalian postoperative therapy concept: A telemedicine guide for the study of ambulatory rehabilitation of patients after cardiac surgery. Telemed J E Health. 2006; 12(4): 475-83. PMID: 16942420 DOI: 10.1089/tmj.2006.12.475
Hailey D, Roine R, Ohinmaa A, Dennett L. Evidence of benefit from telerehabilitation in routine care: A systematic review. J Telemed Telecare. 2011; 17(6): 281-7. PMID: 21844172 DOI: 10.1258/jtt.2011.101208
DOI: http://dx.doi.org/10.30699/fhi.v11i1.368
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