Abstract
Objective
This investigation estimated the incremental cost-effectiveness of high-intensity
training (HIT) compared with conventional physical therapy in individuals with subacute
stroke, based on the additional personnel required to deliver the therapy.
Design
Secondary analysis from a pilot study and subsequent randomized controlled trial.
Setting
Outpatient laboratory setting.
Participants
Data were collected from individuals with locomotor impairments 1-6 months poststroke
(N=44) who participated in HIT (n=27) or conventional physical therapy (n=17).
Interventions
Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground,
treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing
conventional therapy practiced impairment-based and functional tasks at lower intensities
(<40% heart rate reserve).
Main Outcome Measures
Costs were assessed based on personnel use with availability of similar equipment.
Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability
curves were calculated for quality-adjusted life years (QALYs) derived from the Medical
Outcomes Short Form-36 questionnaire and gains in self-selected speeds (SSSs).
Results
Personnel costs were higher after HIT (mean, $1420±234) vs conventional therapy (mean,
$1111±219), although between-group differences in QALYs (0.05 QALYs; 95% confidence
interval [CI], 0.0-0.10 QALYs) and SSS (0.20 m/s; 95% CI, 0.05-0.35 m/s) favored HIT.
ICERs were $6180 (95% CI, −$96,364 to $123,211) per QALY and $155 (95% CI, 38-242)
for a 0.1 m/s gain in SSS.
Conclusions
Additional personnel to support HIT are relatively inexpensive but can add substantial
effectiveness to subacute rehabilitation. Future research should evaluate patient
factors that increase the likelihood of improvement to maximize the cost-effectiveness
of treatment post stroke.
Keywords
List of abbreviations:
CEA (cost-effectiveness analysis), CI (confidence interval), CONV (conventional), HIT (high-intensity training), ICER (incremental cost-effectiveness ratio), QALY (quality-adjusted life year), RCT (randomized controlled trial), SF-36 (Medical Outcomes Survey Short Form-36), SF-6D (Short Form-6 dimension), SSS (self-selected speed), US (United States), VIEWS (Variable Intensive Early Walking Poststroke)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 03, 2021
Accepted:
May 6,
2021
Received in revised form:
April 28,
2021
Received:
March 19,
2021
Footnotes
Supported by the National Institute of Disability, Independent Living, and Rehabilitation Research (grant nos. H133B031127, H133B140012, 90RT502, H133P130013).
Clinical Trial Registration No.: NCT01789853.
Disclosures: none
This paper is part of a supplement from the American Congress of Rehabilitation Medicine.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
