“The addition of an aquatic exercise program to the usual care regimen for fibromyalgia in women is cost effective in terms of both healthcare costs and societal costs,” said Dr. Gusi, of sports sciences at the University of Extremadura in Caceres Spain.
Water exercise improved patients’ quality of life
The study included 33 FM patients randomly assigned to the experimental group (n = 17) or the control group (n = 16). Patients in the experimental group participated in a 1-hour, supervised, water-based exercise sessions, 3 times per week for 8 months.
All patients met American College of Rheumatology (ACR) criteria for FM. Usual care in the study included standard hospital and outpatient clinic care, including primary care, in the Spanish health system. The exercise program took place in a waist-high pool of warm water and was conducted by a qualified exercise leader. Each exercise program included 10 minutes of warm up, 10 minutes of aerobics, 20 minutes of mobility and lower limb strength exercises, another 10 minutes of aerobics, and 10 minutes of cool down exercises.
The study did not include any type of placebo to control for the potentially confounding effects of the extra 3-hours per week of attention and interaction associated with the water exercise program. The primary outcomes were healthcare costs and the number of quality-adjusted life years (QALYs). The researchers reported that mean incremental treatment costs were €517 ↑ for healthcare costs and €1,032 ↑ for societal costs than usual care. Each QALY gained cost an additional €3947 from a healthcare perspective and €788 from a societal perspective. The investment did not reduce consumption of health services. However, this was partly because access to physician visits in the national health service in Spain is already in effect rationed.
“The current study did not find any evidence for decreased use of healthcare services during the study period. However, the lack of change in the ratio of frequency (consultations/month) can be explained partially by the limits of supply and the management of free appointments in the general practices of the National Health System in Spain. A study in a nonlimited supply setting could address the question of whether an aquatic program could reduce the use of other healthcare services,” they said.
The intervention significantly improved quality of life in FM patients compared with standard care. The researchers concluded that the 8-week swimming program is cost effective if the benchmark is €14,200/QALY for healthcare costs or €28,300/QALY from a societal perspective.
This has potential public health implications. The study examined both the direct costs and the associated indirect costs such as disability from work. The authors said, “Patients with FM...incur about twice the healthcare costs of the general population and are absent from work approximately twice as much as other employees.”
Prof. Kaisa Mannerkorpi, who has extensively studied nonpharmacologic interventions for FM, told Musculoskeletal Report that ~30% of FM patients obtain effective symptom relief from drug therapy, “indicating that there are subgroups in FM” that might respond better to other modalities. Prof. Mannerkorpi, of Sahlgrenska Academy at Göteborg University Institute of Medicine in Sweden, added, “I think that, in our world, a piece of knowledge attained by a profession soon spreads to other professions. As a result, most educational programs today include elements of cognitive therapy approach. However, some patients may need and benefit from individual therapy and, in those cases, individual cognitive therapy directed to management of disorder may be the best [approach to] health care.”
Translating research into practice
Although the results of the aquatic exercise intervention look promising, the authors point out that access to and time spent in travel to and from the pool comprised a considerable burden for some patients. They suggest that aquatic exercise should be compared with “land-based therapies such as low-impact aerobics, walk-based exercise, tai chi, etc), which are cheaper and more widely available.
Reference
1. Gusi N, Tomas-Carus P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther. [published online ahead of print February 21, 2008]. 2008; doi:10.1186/ar2377. http://arthritis-research.com/content/10/1/R24.
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