Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial.

INTRODUCTION: Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. METHODS: This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. DISCUSSION: After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants' behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022.

Cost-effectiveness of surgical treatment compared to medical treatment in patients with drug-refractory epilepsy: A systematic review.

BACKGROUND AND PURPOSE: Approximately 30% of epilepsy patients develop a drug-refractory epilepsy, that is, seizures cannot be controlled with antiepileptic drugs. Surgery has been evaluated as an effective but costly form of treatment. The aim of this systematic review is to synthesize the available evidence on the cost-effectiveness of surgical treatment compared to medical treatment for these patients. METHOD: A systematic literature search was performed in MEDLINE, Embase, PsycINFO, Cochrane Library and the National Health Service Economic Evaluation Database until September 2022. Title, abstract and full-text screening were conducted by two researchers. Original studies published in English or German analyzing the cost-effectiveness of surgical compared to medical treatment were included. Study characteristics, effectiveness measures, costs and incremental cost-effectiveness ratios (ICERs) were extracted. The quality of studies was assessed using the Drummond checklist. RESULTS: Fourteen studies were included. Most studies evaluated surgery as cost-effective. The ICER per patient seizure free ranged from dominant to purchasing power parity US dollars (PPP-USD) 479,275. The ICER per 1% seizure reduction ranged from PPP-USD 227 to PPP-USD 342. The ICER per year without seizures was PPP-USD 4202 and the ICER per quality-adjusted life-year ranged from dominant to PPP-USD 90,874. The studies varied greatly in their methodology and time horizon. CONCLUSION: Surgical treatment is cost-effective compared to medical treatment, especially when a lifetime horizon is adopted. It is concluded that all disease-specific costs should be considered over a long period when assessing the cost-effectiveness of epilepsy treatment. From an economic perspective, efforts should be made to improve access to surgical treatment for patients with drug-refractory epilepsy.

Cultural traits and second-generation immigrants' value of informal care.

Many European studies find that immigrants and the native population differ in their long-term care use. These differences have been attributed to immigrants' cultural preferences, among others. However, the cultural integration process of immigrants may result in a potential caregiving conflict between foreign-born immigrants' preferences for long-term care and their children's willingness to provide long-term care. In this study, we empirically assess to what extent cultural factors that prevail in foreign-born immigrants' country of origin are reflected in their children's value of informal care. Using data from the German Family Panel and the World Values Survey/European Values Study, we regressed second-generation immigrants' value of informal care on the cultural strength of family ties that prevails in their parents' country of birth. Probit models were estimated and individual characteristics were accounted for. The results show that second-generation immigrants who originate from cultures with stronger family ties are more likely to express a high value of informal care than second-generation immigrants who come from cultures with weaker family ties. We conclude that immigrants' values of informal care are deeply shaped by their country of origin. Policy makers should keep immigrants' needs and preferences in mind when implementing long-term care interventions. The same set of long-term care interventions can have very different effects, depending on immigrants' values. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00730-1.

Cultural Differences in the Intended Use of Long-Term Care Services in the United States: The Role of Family Ties.

OBJECTIVES: In the light of an increasingly diverse older population in the United States, there is an ongoing discussion on how cultural factors contribute to individual long-term care (LTC) needs and service use. This study empirically assesses whether the level of acculturation and cultural differences in the importance of the family shape foreign-born immigrants' intention to use certain LTC services. METHODS: We correlated immigrants' intention to use certain LTC services to the cultural strength of family ties that prevails in their region of origin. We used data from the National Health Interview Survey and the World Values Survey/European Values Study for analysis. Multinomial logit models were estimated and predisposing, enabling, and need factors were controlled for. Estimations were weighted to account for the sampling structure, and sensitivity analyses were conducted. RESULTS: Immigrants from cultures with stronger family ties are significantly more likely to intend the use of LTC options that include the family. Furthermore, immigrants are less likely to intend the use of exclusively family care when having lived in the United States for a longer time. DISCUSSION: We conclude that cultural differences in family ties shape immigrants' intention to use certain LTC services. If policymakers aim at increasing the provision of specific LTC services or support to family caregivers, there should be a careful evaluation of demand-side factors in an increasingly culturally diverse society.

How Politico-Economic Systems Shape Individuals' Value of Elderly Care: Evidence From the German Reunification.

BACKGROUND AND OBJECTIVES: Perceptions of how societies should care for the elderly people can differ among countries. This study examines to what extent individuals' value of informal care is shaped by the politico-economic system in which they grew up and if this value adjusts once an individual lives in a different politico-economic system. RESEARCH DESIGN AND METHODS: We use data from the German Family Panel and take advantage of the unique setting of the German separation and reunification. Probit models are used to examine the effect of being born in East Germany on individuals' value of informal care relative to employment at different birth cohorts and survey waves (N = 14,093). Average marginal effects are calculated. RESULTS: Twenty years after reunification, East Germans who spent their adolescence under communism exhibit a higher value of informal care relative to employment than West Germans who grew up in a western social market economy. Differences in values between East and West Germans do not significantly converge over time. DISCUSSION AND IMPLICATIONS: Individuals' value of informal care is deeply shaped by the politico-economic system in which they grew up. If immigration policies are introduced to increase the care for elderly people, differences in individuals' cultural perceptions of elderly care should be considered as these will not suddenly adjust.

Costs of informal nursing care for patients with neurologic disorders: A systematic review.

OBJECTIVE: To systematically review the economic burden of informal nursing care (INC), often called informal care, caused by multiple sclerosis (MS), Parkinson disease (PD), and epilepsy, with special attention to disease severity. METHODS: We systematically searched MEDLINE, PsycINFO, and NHS Economic Evaluation Database for articles on the cost of illness of the diseases specified. Title, abstract, and full-text review were conducted in duplicate by 2 researchers. The distribution of hours and costs of INC were extracted and used to compare the relevance of INC across included diseases and disease severity. RESULTS: Seventy-one studies were included (44 on MS, 17 on PD, and 10 on epilepsy). Studies on epilepsy reported an average of 2.3-54.5 monthly hours of INC per patient. For PD, average values of 42.9-145.9 hours and for MS average values of 9.2-249 hours per patient per month were found. In line with utilized hours, costs of INC were lowest for epilepsy (interquartile range [IQR] 229-1,466 purchasing power parity US dollars [PPP-USD]) and similar for MS (IQR 4,454-11,222 PPP-USD) and PD (IQR 1,440-7,117 PPP-USD). In addition, costs of INC increased with disease severity and accounted for 38% of total health care costs in severe MS stages on average. CONCLUSIONS: The course of diseases and disease severity matter for the amount of INC used by patients. For each of the neurologic disorders, an increase in the costs of INC, due to increasing disease severity, considerably contributes to the rise in total health care costs.