Erika Maude, our Clinic Principal, delivered a scientific presentation to the 2019 SOSORT conference in San Francisco last week.
Watch the video below to see her presentation in full.
Video Transcript
Erika Maude: Hello everybody, and thank you for having me along today. This is a continuation of the research that my colleague Jason Black first presented in Lyon two years ago looking at the cost-effectiveness of exercise therapy for adults with scoliosis.
Introduction – Health Economics
Adult patients with idiopathic scoliosis have been shown to present with impaired health-related quality of life. Therefore, in health systems globally, a key objective of treatment is to improve quality of life whilst maintaining cost-effectiveness. The cost-effectiveness of PSSEs [physiotherapeutic scoliosis-specific exercises] has not been researched, and thus conclusions about whether or not they are a viable economic alternative to surgery or bracing for healthcare systems cannot be made.
In the UK, the National Health Service offers spinal fusion surgery as the only treatment for adults with idiopathic scoliosis. They treat about 360 cases per year, each costing £24,853. Under cost-utility analysis, cost-effective analysis estimates the cost of treatment. It is used to inform funding decisions based on the benefit of treatment versus how much it costs. It requires extrapolation of data because it estimates the lifetime benefits of treatment.
Introduction – QALYs
The primary outcome of cost-utility analysis is the cost per quality-adjusted life year, or ‘QALY’ for short – otherwise known as the incremental cost-effectiveness ratio, which I’ll come onto a bit more in a moment. QALYs analyse both the quality and the quantity of life years, where (rather morbidly) 0 equals death and 1 equals perfect health. QALY are accumulative, and thus a 0.2 QALY improvement lasting for 5 years equals 1 QALY for the patient.
The ICER [incremental cost-effectiveness ratio] is calculated as the difference in the expected cost of Intervention A compared to Intervention B divided by the difference in the expected QALYs produced by Intervention A and Intervention B. Generally, it is considered that the interventions costing the UK’s National Health Service less than £30,000 per QALY gained are deemed to be cost-effective.
Introduction – EQ-5D
The EQ-5D is the measure preferred by the UK’s National Institute of Clinical Excellence [NICE] for comparing cost-effectiveness. It’s a descriptive system, and it defines health-related quality of life in terms of five dimensions:
- Mobility
- Self-care
- Usual activities
- Pain and discomfort
- Anxiety and depression
Responses to each of these dimensions are divided into three levels (1st, no problems; 2nd, some to moderate problems; and 3rd, severe to extreme problems), thus generating a total of 243 possible health states. On the left is an example EQ-5D form, which can only be used with licensed permission.
Objectives
The aim of this study was to explore the cost-effectiveness of physiotherapeutic scoliosis-specific exercises for adult patients with idiopathic scoliosis using an intensive, group-based therapy approach.
Method
183 consecutively-recruited UK-based adult patients (with an average age of 38.5 years at the start of treatment) attending the Scoliosis SOS Clinic in London for intensive ScolioGold treatment filled out the EQ5D5L questionnaire at 5 different time points:
- Before treatment
- After treatment
- 6 months check-up
- 12 months check-up
- 18 months check-up
The EQ-5D results were then converted into QALYs using assumptions about the duration of treatment effect. A linear regression model was then used to statistically analyse the results.
Results – Response Rate
Due to the method of data collection, consecutive nature of patient recruitment, and time limitations imposed by the 3-year EQ5D5L licence, 100% of the participants completed the questionnaire pre-treatment, 91% immediately post-treatment, 68% at their 6-month check-up, with 51% at both 12- and 18-month check-ups.
Results – EQ5D5L Scores
Before treatment, the average EQ-5D score was 0.773, and immediately after treatment, this increased to an average of 0.881. At 6 months, the average was 0.862, and at both 12 and 18 months check-up, the average was maintained at 0.863. All of these changes were statistically significant.
Results – Calculation of QALYs
Although patient scores were statistically much improved at 12 and 18 months post-treatment, due to the fewer number of patients who reached the later time points, reliable data was only available up to 6 months following treatment, and therefore an assumption on the persistence of the treatment effect is required for later time points. To look at both extremes: assuming that the treatment benefit ended after just six months, additional QALYs were 0.045, which means that the ICER would be £90,000 per QALY. However, assuming that the treatment effect continued for 43.8 years (the average life expectancy of the patients in this study), then additional QALYs were 3.899, meaning the ICER would fall to just £1,000 per QALY.
Therefore, to meet NICE’s requirements for health economics, the effects of treatment would need to persist for 1.5 years.
Conclusion
In conclusion, EQ-5D results improved with PSSE in adult patients with idiopathic scoliosis. If the treatment effect of the PSSEs persists for only 1.5 years, it is expected to be cost-effective in UK-based adults. Further long-term research is required to start planning for PSSE to become available within national healthcare services; with publication of these results, we hope to highlight that the input of physiotherapy in this patient group should warrant funding.
Limitations
We are aware that there are several limitations to this study, namely lack of a control group, limited long-term follow-up, and no data on cost savings from exercise therapy.
Thank you for listening.
More Scoliosis Research > About Erika and the Team >
The final 2 days of the 2019 SOSORT (Society On Scoliosis Orthopaedic and Rehabilitation Treatment) meeting in San Francisco proved to be just as productive and educational as the start of the conference.
Friday 26 April
Friday began with a variety of scientific paper award sessions, including those on the ‘Impact of Sports Activities on Adolescent Scoliosis Patients’ (from a team at the Italian Scientific Institute) and the ‘Effects of Inspiratory Muscle Training on Respiratory Muscle Strength’ (from a research group at Bezmiâlem University in Istanbul, Turkey). This was followed by a moving presentation from Dr. Scott Haldeman on the work of World Spine Care, a global charity on a mission to improve lives in under-served communities by aiming to create a world in which everyone has access to the highest possible quality of spine care.
Clinic Principal Erika Maude (pictured above) then presented the Scoliosis SOS Clinic’s work: ‘Exploring the Cost Effectiveness of an Intensive Physiotherapeutic Scoliosis Specific Exercise (PSSE) Programme in a UK Adult Population’. Many of our patients will recall being asked to complete quality of life questionnaires at various points during their treatment programmes, and we are very grateful to everyone who has helped to contribute to this ground-breaking piece of research and prove that our ScolioGold therapy is a cost-effective alternative to the existing treatments of bracing and surgery that are currently offered by the UK’s National Health Service. We will be uploading the full video recording of Erika ‘s presentation at the San Francisco conference later next week.
The day concluded with a talk from orthopaedic specialist Mr Peter Newton, current president of the SRS (Scoliosis Research Society), on the organisation’s work as a networking hub for spinal specialists from all over the world.
Saturday 27 April
Saturday saw Rachel Mulvaney, Vice President of Curvy Girls, speak on the ‘Power of Peer Support’ and showcase the amazing work this society does to help girls with scoliosis across the globe.
Our Clinical Manager Georgie Frere (pictured above) also gave an excellent insight into the importance of ‘Strategies to Improve Home Exercise Compliance in Patients with Scoliosis’, something that we are very passionate about supporting our patients with when they return home after completing a treatment course at our clinic. Every patient receives a personalised exercise schedule, and we have also been trialling the use of paper exercise diaries for some of our patients to see if this improves their motivation at home. Georgie’s presentation has also been recorded and will be uploaded to our YouTube channel shortly.
Looking ahead to SOSORT 2020
Next year’s SOSORT conference will be held in Melbourne, Australia, and the Scoliosis SOS team are already hard at work finalising their scientific abstracts for submission before the deadline in October 2019. The 2020 conference looks set to be bigger than ever, and will be teaming up with SpineWeek to offer a scientific collaboration bringing together clinicians and scientists from around the world and from very different scientific societies.
Learn More About Scoliosis SOS > Upcoming Treatment Course Dates >
SOSORT (Society On Scoliosis Orthopaedic and Rehabilitation Treatment) is a non-profit organisation that aims to encourage the development of conservative – i.e. non-surgical – treatment methods for scoliosis and other spinal conditions. The cornerstone of SOSORT’s work is their Annual Meeting, which takes place in a different location each year and comprises a variety of scientific and educational events.
The Scoliosis SOS Clinic have had a consistent presence at these Annual Meetings for a number of years now. Clinic Principal Erika Maude, Clinic Manager Georgie Frere and ScolioGold Therapist Kara Cattell are currently in San Francisco, California for SOSORT’s 14th International Conference on Scoliosis Management. This year, more than 300 participants from across 6 different continents have gathered together to discuss the latest developments, research and techniques for non-surgical scoliosis patient care.
On Thursday, attendees listened to lectures from keynote speakers Dr Manuel Rigo – who was Erika’s doctor when she herself underwent treatment in Spain back in 2002 – and Dr Stuart Weinstein, an orthopaedic surgeon and US healthcare policy advisor.
Dr Rigo gave a brilliant insight into the history of exercise-based therapy for scoliosis (dating back to the 18th century, when wall bars were first invented by a Swedish physician) and finished with an overview of modern-day physiotherapy methods from around the world.
Dr Weinstein’s talk focused on health economics and how, with scoliosis surgery being one of the biggest health costs for teenage populations in many countries, healthcare providers are going to be under increasing pressure in the near future to find more cost-effective ways to treat this patient group – namely with less invasive, more conservative methods. This is a particularly popular topic at the moment, and Erika hopes that her upcoming scientific presentation on the health economics of patient quality of life will greatly add to the evidence supporting the wider use of exercise therapy to treat scoliosis patients.
Be sure to check the Scoliosis SOS blog next week for more information on Erika’s presentation, as well as Georgie’s presentation on patient compliance.
Our Scoliosis Research > Our Treatment Method >
Last night (10 April 2019), 18-year-old Chloe Donhou from Essex underwent spinal fusion surgery to correct her 60+ degree scoliosis. This wouldn’t normally be headline news – scoliosis affects approximately 3% of the population, and countless spinal fusion procedures are carried out worldwide each year – but Chloe’s operation was noteworthy because it was televised.
Channel 5’s Operation Live is a groundbreaking television series that’s exactly what its title suggests: live TV broadcasts of surgical operations, interspersed with commentary from the medical professionals involved. At the centre of last night’s instalment was Chloe, who has spent much of the last 18 years in pain as a result of her spinal curvature.
Speaking to the Express ahead of her operation, Chloe said: “This is something I’ve been waiting for my whole life. It’s finally happened. It’s the little things people don’t understand…if I go bowling with friends, I’ll be in agony the next day.”
Chloe’s spinal fusion procedure was carried out by the orthopaedic team at The Royal London Hospital, and watched by viewers all over the UK.
Read some of the reactions to Chloe’s spinal fusion surgery on Twitter >
Is spinal fusion surgery the only answer for people with scoliosis?
Here at the Scoliosis SOS Clinic, we provide exercise-based physical therapy that helps people with scoliosis to live better lives. We quite frequently hear from individuals who are looking for alternatives to spinal fusion surgery – as effective as the operation is, there’s always a risk associated with any surgical procedure, and many scoliosis patients prefer not to go through with it.
Over the last 12-13 years, we have helped many people with scoliosis to improve their condition and avoid spinal fusion surgery. Our internationally-renowned ScolioGold treatment method has proven capable of:
- Reducing pain
- Making spinal curves smaller
- Improving muscle balance and flexibility
- Boosting overall quality of life
If you would like to find out more about the Scoliosis SOS Clinic and the treatment we provide, please telephone 0207 488 4428 or fill out our online enquiry form.
Before & After X-Rays > Book a Consultation >
Related links:
