Epps (2005) Is hydrotherapy cost-effective, A randomised controlled trial of combined hydrotherapy programmes

Introduction

Juvenile Idiopathic Arthritis (JIA) poses a significant health challenge, lacking a definitive cure but manageable through various therapies. This study explores the comparative effectiveness and cost-efficiency of combined hydrotherapy and land-based physiotherapy versus land-based physiotherapy alone in treating JIA in children. The goal is to discern the most beneficial approach in terms of health outcomes and economic viability.

Study Design and Methodology

A robust multi-centre randomised controlled trial was set up involving 200 patients divided into two groups: one receiving land-based physiotherapy (land group) and the other a combination of hydrotherapy and land-based physiotherapy (combined group). Patients, aged 4–19 years with a diagnosis of idiopathic arthritis, underwent 16 one-hour treatment sessions over two weeks, followed by continued local physiotherapy for two months. The primary and secondary outcomes were meticulously measured to assess disease improvement, health-related quality of life (HRQoL), and various cost factors.

Results and Findings

The study found that 47% of the combined group showed disease improvement, compared to 61% in the land group, with no significant differences in mean costs and quality-adjusted life years (QALYs) between the groups. While both treatments demonstrated safety and effectiveness, the combined therapy showed a slight edge in improving physical aspects of HRQoL and cardiovascular fitness.

Conclusions and Implications

The findings suggest that both hydrotherapy combined with land-based physiotherapy and land-based physiotherapy alone are effective and safe for treating JIA, without significant cost or QALY differences. The limited sample size may have obscured potential disparities between the groups. The study concludes that the additional costs of hydrotherapy facilities may not be justified for all JIA patients, except perhaps those with severe active disease not included in the trial. Further research is recommended to refine outcome measures, improve trial methodologies, and explore patient satisfaction across different therapy modes.

Keywords: JIA, hydrotherapy, physiotherapy, health-related quality of life, cost-effectiveness, randomized controlled trial.