Cost-effectiveness of the My Therapy self-directed therapy program for rehabilitation patients: A stepped wedge cluster randomised trial.
Natasha K Brusco, Sara L Whittaker, Christina L Ekegren and 8 others
PMID 40509561WHAT IT FOUND
Adding a self-directed therapy program to usual care did not improve patient function or quality of life compared to usual care alone.
While the program cost little per admission and increased therapy time by 26 minutes daily, it failed to achieve clinically significant gains in the primary outcomes.
Key findings
01The intervention did not lead to clinically significant improvements in participant function or quality of life compared to usual rehabilitation alone.
02The program could be implemented without an associated increase in the cost per admission.
03Therapy participation increased by 26 minutes a day with the intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The trial was conducted during the COVID-19 pandemic, which shifted patient demographics to include more complex medical patients and fewer elective orthopaedic patients, particularly during the intervention phase. Hospital visitor restrictions were in place, which the authors note was a key enabler for the self-directed therapy program. The time horizon for cost analysis was short (30 days post-discharge), potentially missing longer-term cost savings or benefits. The dosage of self-directed therapy (26 minutes/day) may have been insufficient to achieve functional gains. Cognitive outcomes were not the primary focus, though most participants did not have severe cognitive impairment.
Declared interests
The study was funded by a Future Leader Fellowship from the National Heart Foundation of Australia and the National Health and Medical Research Council (NHMRC). No commercial conflicts of interest are explicitly detailed in the provided text, but the funding sources are government and non-profit health foundations.
The easy way to misread this
Do not conclude that self-directed therapy is ineffective because the primary outcomes were null. The authors suggest the additional therapy dose (26 minutes/day) may have been too low to impact function, or that pandemic-related case-mix changes confounded the results. The intervention did increase therapy participation and was cost-neutral, so it may still have value as part of a broader strategy to increase total therapy dose.