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Rezvani F, Heider D, König HH, Herbarth L, Steinisch P, Schuhmann F, Böbinger H, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, Härter M, Dirmaier J. Telephone Health Coaching and Remote Exercise Monitoring (TeGeCoach) in Peripheral Arterial Occlusive Disease—a Randomized Controlled Trial. Dtsch Arztebl Int 2024:arztebl.m2024.0008. [PMID: 38269534 DOI: 10.3238/arztebl.m2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Supervised exercise programs are commonly used to treat intermittent claudication (IC). Home-based exercise programs have been developed to lower barriers to participation. We studied the effects of one such program (TeGeCoach) on self-reported walking ability in patients with IC. METHODS In a pragmatic, multicenter, randomized and controlled trial (registration number NCT03496948), 1982 patients with symptomatic IC, insured by one of three German statutory health-insurance carriers, received either telephone health coaching with remote exercise monitoring (TeGeCoach; n = 994) or routine care (n = 988). The primary outcome was the change in Walking Impairment Questionnaire (WIQ) scores 12 and 24 months after the start of the intervention (intention-to-treat analysis). The secondary outcomes were health-related quality of life, symptoms of depression or anxiety, health competence, patient activation, alcohol use, and nicotine dependence. RESULTS There was a significant difference between arms in favor of TeGeCoach in the WIQ (p<0.0001). Patients in the TeGeCoach arm had WIQ scores that were 6.30 points higher at 12 months (Bonferroni-corrected 95% CI [4.02; 8.59], Cohen's d = 0.26) and 4.55 points higher at 24 months ([2.20; 6.91], d = 0.19). They also fared better in some of the secondary outcomes at 12 months, including physical health-related quality of life and patient activation, with at least small effect sizes (d > 0.20). The average daily step count was no higher in the TeGeCoach group. CONCLUSION The observed reductions of symptom burden indicate the benefit of home-based exercise programs in the treatment of intermittent claudication. Such programs expand the opportunities for the guideline-oriented treatment of IC. Future studies should address the effect of home-based exercise programs on clinical variables, e.g., the 6-minute walk test.
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Heider D, Rezvani F, Matschinger H, Dirmaier J, Härter M, Herbarth L, Steinisch P, Böbinger H, Schuhmann F, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, König HH. The effect of telephone health coaching and remote exercise monitoring for peripheral artery disease (TeGeCoach) on health care cost and utilization: results of a randomized controlled trial. Eur J Health Econ 2023:10.1007/s10198-023-01616-4. [PMID: 37428355 DOI: 10.1007/s10198-023-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is the third most prevalent atherosclerotic cardiovascular disease. In 2016, costs per patient associated with PAD exceeded even the health-economic burden of coronary heart disease. Although affecting over 200 million people worldwide, a clear consensus on the most beneficial components to be included in home-based exercise programs for patients with peripheral artery disease is lacking. The aim of the study was to examine the health care use and costs caused by the 12-month patient-centered 'Telephone Health Coaching and Remote Exercise Monitoring for Peripheral Artery Disease' (TeGeCoach) program in a randomized controlled trial. METHODS This is a two-arm, parallel-group, open-label, pragmatic, randomized, controlled clinical trial (TeGeCoach) at three German statutory health insurance funds with follow-up assessments after 12 and 24-months. Study outcomes were medication use (daily defined doses), days in hospital, sick pay days and health care costs, from the health insurers' perspective. Claims data from the participating health insurers were used for analyses. The main analytic approach was an intention-to-treat (ITT) analysis. Other approaches (modified ITT, per protocol, and as treated) were executed additionally as sensitivity analysis. Random-effects regression models were calculated to determine difference-in-difference (DD) estimators for the first- and the second year of follow-up. Additionally, existing differences at baseline between both groups were treated with entropy balancing to check for the stability of the calculated estimators. RESULTS One thousand six hundred eighty-five patients (Intervention group (IG) = 806; Control group (CG) = 879) were finally included in ITT analyses. The analyses showed non-significant effects of the intervention on savings (first year: - 352€; second year: - 215€). Sensitivity analyses confirmed primary results and showed even larger savings. CONCLUSION Based on health insurance claims data, a significant reduction due to the home-based TeGeCoach program could not be found for health care use and costs in patients with PAD. Nevertheless, in all sensitivity analysis a tendency became apparent for a non-significant cost reducing effect. TRIAL REGISTRATION NCT03496948 (www. CLINICALTRIALS gov), initial release on 23 March 2018.
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Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Herbarth
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Patrick Steinisch
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Hannes Böbinger
- TK Techniker Krankenkasse Statutory Health Insurance, Hamburg, Germany
| | | | - Gundula Krack
- mhplus Krankenkasse Statutory Health Insurance, Ludwigsburg, Germany
| | | | | | | | | | - Mark-Dominik Alscher
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Benjamin Finger
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Weber F, Müller C, Bahns C, Kopkow C, Färber F, Gellert P, Otte I, Vollmar HC, Brannath W, Diederich F, Kloep S, Rothgang H, Dieter V, Krauß I, Kloek C, Veenhof C, Collisi S, Repschläger U, Böbinger H, Grüneberg C, Thiel C, Peschke D. Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial. BMC Musculoskelet Disord 2023; 24:221. [PMID: 36959595 PMCID: PMC10034894 DOI: 10.1186/s12891-023-06255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
Introduction Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. Methods This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. Discussion After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. Trial registration German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-023-06255-7.
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Affiliation(s)
- Franziska Weber
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carsten Müller
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Carolin Bahns
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Francesca Färber
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ina Otte
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Freya Diederich
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Stephan Kloep
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Valerie Dieter
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Inga Krauß
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Corelien Kloek
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Cindy Veenhof
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Sandra Collisi
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Ute Repschläger
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Hannes Böbinger
- grid.492243.a0000 0004 0483 0044Innovationsfonds & Produktportfolio, Techniker Krankenkasse, Hamburg, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Dirk Peschke
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
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