OBJECTIVE: To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective.
DATA SOURCES: Six databases were searched until December 2023.
STUDY SELECTION: Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life.
DATA EXTRACTION: After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer.
DATA SYNTHESIS: Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, -AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained).
CONCLUSIONS: Self-management as an intervention is low cost and could improve health-related quality of life.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
Rehab Clinician (OT/PT) rater
As a physical therapist, I found the clinical application of the study's results to be obscure. Perhaps self management is better targeted to certain medical populations, but we do not know this from this study. The sample was so varied between different health professionals managing medical conditions from severe neurological, cardiopulmonary, musculoskeletal and cancer illnesses. It is difficult to know which conditions are best served by self management techniques and by whom. Also, the authors state that self-management program needed to be completed outside the supervised or structured therapy sessions. This appears to be an oxymoron i.e., by the very definition of supervised therapy self management is a key treatment ingredient. Why were additional self management sessions required outside of the rehabilitation plan of care?
Rehab Clinician (OT/PT) rater
The data provided through the meta analysis was difficult for me to apply to daily clinical decision-making regarding costs. However the addition of self-management to usual physical therapy services positively impacting outcomes makes sense.
Rehab Clinician (OT/PT) rater
This is an excellent way to get our patients involved in their own care and to help develop strategies that can be implemented for their success.
Rehab Clinician (OT/PT) rater
Although the inclusion of studies on different populations reduces the reliability of the findings, the study can still guide clinicians.
, McMaster University