Cost-Effectiveness of Physical Therapist Treatment in Addition to Usual Podiatry Management of Plantar Heel Pain: Economic Evaluation of a Randomized Clinical Trial.

The study was done at one US-based multidisciplinary clinic, so it may not apply to other settings. The base case analyzed 48 people in the added physical therapy group and 47 people in the usual podiatry group, so the sample was relatively small. People with plantar heel pain symptoms for longer than 1 year were excluded, so the study does not show cost-effectiveness in a more chronic population. Some patient-reported cost and outcome data were missing, with 8.6% of data imputed overall and year 2 absenteeism and presenteeism missing in 30% of cases. Self-reported costs relied on 1-year recall at the 2- and 3-year assessments. Mental health service use and costs from loss of recreational activities were not captured. The study did not test direct-access physical therapy without initial podiatry care, and scope of practice varies between physical therapists and podiatrists.

The study was funded by the Academy of Orthopaedic Physical Therapy, APTA, Inc. and the Des Moines University Iowa Osteopathic Education Research Fund. The funders played no role in the design, conduct, or reporting of the study.

Do not read this as proof that physical therapist treatment alone caused the lower costs and higher quality-adjusted life-years. The physical therapist group also received usual podiatry care, which could include anti-inflammatory medication, injection, exercise instruction, orthoses, or footwear advice. The contribution of any single component cannot be separated.