Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention for people with rheumatoid arthritis or axial spondyloarthritis and a reduced work ability: a randomized, controlled trial

N F Bakker¹, J Knoop², W B van den Hout³, N Hutting⁴, J A Engels⁴, J B Staal^{4

5}, M van der Leeden^{6

7}, A Boonen^{8

9}, A Willemze¹⁰, M T Nurmohamed¹¹, T P M Vliet Vlieland¹², M G J Gademan^{12

13}, S F E van Weely^{12

14}

Affiliations

¹ Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P. O. Box 9600, Leiden, 2300 RC, The Netherlands. n.f.bakker@lumc.nl.
² Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
³ Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Research Group Occupation and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
⁵ IQ health, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶ Reade, Rehabilitation and Rheumatology, Amsterdam, The Netherlands.
⁷ Rehabilitation Medicine Department and Amsterdam Movement Sciences Research Institute, Ageing and Vitality, Amsterdam UMC (location Vrije Universiteit Amsterdam), Amsterdam, The Netherlands.
⁸ Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
¹⁰ Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands.
¹¹ Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
¹² Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P. O. Box 9600, Leiden, 2300 RC, The Netherlands.
¹³ Department of Clinical epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
¹⁴ Institute of Allied Health Professions, HU University of Applied Sciences, Utrecht, The Netherlands.

PMID: 41396281
DOI: 10.1007/s00296-025-06016-w

Randomized Controlled Trial

Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention for people with rheumatoid arthritis or axial spondyloarthritis and a reduced work ability: a randomized, controlled trial

N F Bakker et al. Rheumatol Int. 2025.

. 2025 Dec 15;46(1):11.

doi: 10.1007/s00296-025-06016-w.

Authors

Affiliations

¹ Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P. O. Box 9600, Leiden, 2300 RC, The Netherlands. n.f.bakker@lumc.nl.
² Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
³ Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Research Group Occupation and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
⁵ IQ health, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶ Reade, Rehabilitation and Rheumatology, Amsterdam, The Netherlands.
⁷ Rehabilitation Medicine Department and Amsterdam Movement Sciences Research Institute, Ageing and Vitality, Amsterdam UMC (location Vrije Universiteit Amsterdam), Amsterdam, The Netherlands.
⁸ Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
¹⁰ Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands.
¹¹ Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
¹² Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P. O. Box 9600, Leiden, 2300 RC, The Netherlands.
¹³ Department of Clinical epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
¹⁴ Institute of Allied Health Professions, HU University of Applied Sciences, Utrecht, The Netherlands.

PMID: 41396281
DOI: 10.1007/s00296-025-06016-w

Abstract

To evaluate the (cost-)effectiveness of a physiotherapist-led, multimodal vocational intervention compared to usual care in adults with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) experiencing reduced work ability. (Self-)employed people with RA or axSpA and reduced work ability were randomized to a 12-month vocational intervention or usual care. Assessments were conducted at baseline, 3, 6, and 12 months. Primary outcome was the Work Ability index Single-item Scale (WAS) at 12 months. Secondary outcomes included additional work-related and clinical outcomes. Cost-effectiveness was evaluated using the EuroQol to estimate quality-adjusted life years (QALYs), alongside healthcare use and productivity data. Primary analyses followed an intention-to-treat approach. A total of 140 participants (80 RA, 60 axSpA) were randomized 1:1 to the intervention or control group. At 12 months, the intervention showed no significant benefits over usual care on the WAS (estimated mean difference (MD): 0.40, 95% confidence interval (CI): - 0.22, 1.01) or any of the secondary outcomes. The QALYs were in favor of the intervention group by 0.05. The mean intervention costs were €395 per participant (90% usage, mean 9.5 sessions). After 12 months, the societal costs were €4324 lower in the intervention group (95% CI €-8169, €-479), mainly due to higher medication and presenteeism costs in the control group. At a willingness-to-pay threshold of €20.000/QALY, the intervention had a 99% probability of being cost-effective compared to usual care. While the intervention did not affect work ability in individuals with RA or axSpA, it outperformed usual care from a health-economic perspective, demonstrating its cost-effectiveness and potential value. International Clinical Trial Registry Platform (ICTRP) registration link: ICTRP Search Portal.

Keywords: Axial spondyloarthritis; Cost-utility; Physical therapy modalities; Randomized controlled trial; Rheumatoid arthritis; Vocational rehabilitation.

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Conflict of interest statement

Declarations. Conflict of interest: N.F. Bakker, J. Knoop, W. B. van den Hout, N. Hutting, J.A. Engels, J.B. Staal, M. van der Leeden, A. Willemze, M.T. Nurmohamed, T.P.M. Vliet Vlieland, M.G.J. Gademan and S.F.E. van Weely declare that they have no conflict of interest. A. Boonen received research grants from Abbvie and Lilly, and honoraria for lectures or consultation from Pfizer, Novartis, UCB, Abbvie and Galapagos; all to her department. Ethical approval: to conduct the study was obtained on the 22th of July 2021 from the Medical Ethics Committee Leiden The Hague Delft (P21.050). This study was conducted in agreement with the declaration of Helsinki and in compliance with the General Data Protection Regulations and the Dutch Medical Research Involving Human Subjects Act. All participants provided written informed consent for their participation. The study protocol was included in the International Clinical Trial Registry Platform (ICTRP) under number NL-OMON26117 (ICTRP Search Portal). Open access publishing note: This article is published under an open access license and is freely available to the public. Readers are permitted to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author, provided proper citation is given. Related Congress abstract publication: This study was selected by the European Alliance of Associations for Rheumatology (EULAR) Congress 2025 (11–14 June) for an oral abstract presentation. The congress abstract was online published by EULAR: Bakker NF, van Weely SFE, Hutting N, Heerkens YF, Engels JA, Staal JB, van der Leeden M, Boonen A, van den Hout WB, Vliet Vlieland TPM, Knoop J. Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention in people with inflammatory arthritis: study protocol of the Physiotherapy WORKs trial. BMC Rheumatol. 2023 Sep 20;7(1):31. doi: https://doi.org/10.1186/s41927-023-00357-4 .

References

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Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention for people with rheumatoid arthritis or axial spondyloarthritis and a reduced work ability: a randomized, controlled trial

Affiliations

Effectiveness and cost-effectiveness of a multimodal, physiotherapist-led, vocational intervention for people with rheumatoid arthritis or axial spondyloarthritis and a reduced work ability: a randomized, controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical