Economic evaluations of physiotherapy interventions for neurological disorders: a systematic review

Abstract

Purpose: To identify the existing evidence evaluating the cost-effectiveness of physiotherapy treatments for people with neurological disorders.Methods: Multiple databases were searched from database inception until July 2018. Studies estimating the cost-effectiveness as incremental cost-effectiveness ratios, cost per quality-adjusted life year, cost per disability-adjusted life year and cost per other measurable results were included. Physiotherapy Evidence Database scale, and Consensus on Health Economic Criteria list were used for rating the quality of the evidence.Results: Ten studies involving 1462 participants were included. Aerobic training, progressive strength training, and a pragmatic physiotherapy program (combination of stretching, strength, and balance training) were reported as potentially cost-effective for older adults with vascular cognitive impairment, falls prevention in Parkinson's disease and multiple sclerosis respectively. Physiotherapy as an adjuvant for pain control was also reported as cost-effective for reflex sympathetic dystrophy. One study testing extra physiotherapy-by-physiotherapy assistant in cerebral palsy and two studies testing extra therapy using a robotic arm and Wii therapy for hand rehabilitation in stroke were reported as not cost-effective.Conclusions: There are limited studies that have evaluated the cost-effectiveness of physiotherapy treatments in neurological disorders. Three studies that combined extra physiotherapy-by-physiotherapy assistant and novel interventions with conventional physiotherapy were found not cost-effective.Implications for RehabilitationProgressive muscle strengthening exercise over a period of 6-month is reported to be cost-effective for falls prevention in people with Parkinson's diseaseAerobic training is reported as potentially cost-effective for older adults with vascular cognitive impairmentPhysiotherapy given as an adjuvant treatment is reported to be potentially cost-effective for reflex sympathetic dystrophy of less than 1-year durationOne study reported physiotherapy involving static stretching, aerobic exercise, strengthening exercise, and balance training as cost-effective for people with multiple sclerosisAdditional physiotherapy-by-physiotherapy assistant or family member for improving motor development in cerebral palsy and the use of novel physiotherapy techniques such as robotics or Wii plus conventional physiotherapy for improving arm function in stroke are found not cost-effectiveGroup therapy for improving physical activity in mild Alzheimer's disease is found not cost-effective.

Keywords: Cost-effectiveness; DALY; QALY; economic analyses; neurorehabilitation; physical therapy treatments.