Cochrane (2005) Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis

Introduction to Water-Based Therapy in Osteoarthritis Management

Osteoarthritis (OA) is a prevalent joint disorder affecting the elderly, particularly in the lower limbs, leading to pain and reduced physical function. Traditional management strategies often fall short in providing adequate symptom relief. In response, community water-based therapy emerges as a promising adjunct treatment, potentially offering significant benefits in managing lower limb OA. This study investigates the efficacy of water-based exercise in alleviating OA symptoms and its economic implications compared to usual care.

Study Design and Implementation

The research comprised a pre-experimental study followed by a randomized controlled trial (RCT) to assess the effectiveness of water-based exercise for older patients with hip or knee OA. Conducted in the UK, the study involved 106 participants in the preliminary phase and 312 in the main RCT, comparing the outcomes of water exercise against standard care. The intervention spanned one year, with an additional six-month follow-up to gauge long-term effects and adherence.

Impact on Pain and Physical Function

Initial findings from the pre-experimental study confirmed the short-term benefits of water-based exercise, demonstrating significant improvements in pain and physical function as measured by the WOMAC index. However, the main RCT revealed a modest reduction in pain scores at one year, which diminished by the 18-month follow-up. Despite the decline in adherence post-intervention, the study highlighted the potential of water-based therapy in enhancing physical capabilities and pain management in OA patients.

Economic Evaluation and Cost-Effectiveness

The economic analysis presented a favorable cost-benefit scenario, with water-based therapy yielding a net saving per patient annually and demonstrating cost-effectiveness in terms of quality-adjusted life years (QALYs). These results suggest that community water-based exercise could be a viable and financially sustainable option for OA management in the elderly.

Conclusions and Future Directions

Group-based water exercise offers a viable option for reducing pain and improving physical function in older adults with lower limb OA. Despite the modest effect size and decreased adherence over time, the favorable economic outcomes warrant further exploration into such interventions. Future research should focus on tailoring exercises to individual OA subtypes and addressing barriers to physical activity access for the elderly. This study underscores the potential of water-based therapy as a complementary approach to conventional OA management, meriting deeper investigation into its long-term benefits and integration into public health strategies.

Keywords: Water-based therapy, lower limb osteoarthritis, older patients, pain management, physical function, cost-effectiveness, WOMAC pain score.