Evaluation of different exercise trainings applied in patients with chronic pain from exercise adherence, clinical and economic perspectives

This study was conducted with 519 patients in order to examine the clinical and cost-effectiveness of different exercise trainings in patients with chronic pain and the adherence of the patients to the exercises given. The patients were divided into 3 groups as home-based exercise groups, physiotherapist-led groups and home-based follow up groups, and traditional physical therapy was applied for a total of 10 sessions. The patients were offered exercises in the form of a brochure to the home-based exercise groups, applied to the exercise group under the guidance of a physiotherapist, and to the home-based follow up groups in a way that reminded them of the exercises by sending a daily text message (SMS) after they were given exercise training accompanied by a physiotherapist. They were told to continue their exercises after the treatment. All groups were evaluated in terms of economic, clinical, quality of life, exercise adherence, and satisfaction three times: before the treatment, after the treatment, and three months after the treatment. Cost utility analysis (QALY) and cost-effectiveness ratio (ICER) were used as part of the economic evaluation. Oswestry Disability Index (ODI) and Neck Disability Index (NDI) were used for clinical evaluation. Quality of life was assessed with the EuroQol General Quality of Life Scale (EQ-5D-5L). A scale consisting of 5 (five) questions prepared by us was used for adherence with the exercise. In the evaluation of satisfaction, individuals were asked to give a score between 0-100. All three groups were called to the hospital for control three months later, and the 5-question scale prepared by us was directed to the patients and it was determined how the given exercises were done. It was determined that the exercise group physiotherapist-led groups was better than the other two groups in terms of health status after treatment, health status after three months, and QALY after treatment (p<0.05). In QALY measurements after three months, the results were found to be similar (p>0.05). The QALY gains in the physiotherapist-led groups and the the home-based follow up groups were the same, and the the home-based follow up groups and the physiotherapist-led groups were found to be more cost-effective compared to the home-based exercise groups. The accuracy of the exercises performed in the home-based exercise groups was worse than the other groups. The accuracy of the exercises was found to be better in the home-based follow up groups than in the exercise group accompanied by a physiotherapist (p<0.05). Satisfaction with the treatment was similar in all groups (p>0.05). As a result, the physiotherapist-led groups was found to be cost-effective compared to the other groups. It was concluded that well explaining the exercises given to the patients by the physiotherapists and following the exercises at regular intervals would increase the adherence with the exercise and bring benefits both clinically and economically.