BACKGROUND: Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective.METHODS: This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.RESULTS: Intervention costs and medication costs were significantly lower in e-Exercise compared to usual physiotherapy. Total societal costs and total healthcare costs did not significantly differ between groups. No significant differences in effectiveness were found between groups. For physical functioning and physical activity, the maximum probability of e-Exercise being cost-effective compared to usual physiotherapy was moderate (< 0.82) from both perspectives. For QALYs, the probability of e-Exercise being cost-effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of 10,000 Euro and 0.70/0.80 at a willingness to pay of 80,000 Euro per gained QALY, from respectively the societal and the healthcare perspective.CONCLUSIONS: E-Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee osteoarthritis, but not cost-effective from the societal- as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist.TRIAL REGISTRATION: NTR4224 (25 October 2013).
The ENWHP project and campaign Promoting Healthy Work for Employees with Chronic Illness (PH Work) should contribute towards the implementation of effective workplace health practices within corporate policies of enterprises in Europe. More specific the project should stimulate activities and policies in companies for: -retaining and encouraging return to work (RTW) of chronically ill employees. -preventing employees of moving into disability or early retirement. To contribute to an improvement of social and economic outcomes, like better quality of life and functioning, reduced costs because of lower absence rate, etc. PH Work campaign will look into current good practices, as to motivate and stimulate employers and employees on the promotion of healthy work for all. Running time of ENWHP PH Work project is from April 2011 till February 2013
AimsTo explore the possible extension of the illness script theory used in medicine to the nursing context.DesignA qualitative interview study.MethodsThe study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data.ResultsThrough the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems.ConclusionThe knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain.ImpactIllness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.
Manual labour is an important cornerstone in manufacturing and considering human factors and ergonomics is a crucial field of action from both social and economic perspective. Diverse approaches are available in research and practice, ranging from guidelines, ergonomic assessment sheets over to digitally supported workplace design or hardware oriented support technologies like exoskeletons. However, in the end those technologies, methods and tools put the working task in focus and just aim to make manufacturing “less bad” with reducing ergonomic loads as much as possible. The proposed project “Human Centered Smart Factories: design for wellbeing for future manufacturing” wants to overcome this conventional paradigm and considers a more proactive and future oriented perspective. The underlying vision of the project is a workplace design for wellbeing that makes labor intensive manufacturing not just less bad but aims to provide positive contributions to physiological and mental health of workers. This shall be achieved through a human centered technology approach and utilizing advanced opportunities of smart industry technologies and methods within a cyber physical system setup. Finally, the goal is to develop smart, shape-changing workstations that self-adapt to the unique and personal, physical and cognitive needs of a worker. The workstations are responsive, they interact in real time, and promote dynamic activities and varying physical exertion through understanding the context of work. Consequently, the project follows a clear interdisciplinary approach and brings together disciplines like production engineering, human interaction design, creative design techniques and social impact assessment. Developments take place in an industrial scale test bed at the University of Twente but also within an industrial manufacturing factory. Through the human centered design of adaptive workplaces, the project contributes to a more inclusive and healthier society. This has also positive effects from both national (e.g. relieve of health system) as well as individual company perspective (e.g. less costs due to worker illness, higher motivation and productivity). Even more, the proposal offers new business opportunities through selling products and/or services related to the developed approach. To tap those potentials, an appropriate utilization of the results is a key concern . The involved manufacturing company van Raam will be the prototypical implementation partner and serve as critical proof of concept partner. Given their openness, connections and broad range of processes they are also an ideal role model for further manufacturing companies. ErgoS and Ergo Design are involved as methodological/technological partners that deal with industrial engineering and ergonomic design of workplace on a daily base. Thus, they are crucial to critically reflect wider applicability and innovativeness of the developed solutions. Both companies also serve as multiplicator while utilizing promising technologies and methods in their work. Universities and universities of applied sciences utilize results through scientific publications and as base for further research. They also ensure the transfer to education as an important leverage to inspire and train future engineers towards wellbeing design of workplaces.
It is essential to look for new forms of care, with an emphasis on Prevention, Relocation and Replacement (Health & Care Knowledge and Innovation Agenda 2020-2030). Especially when it comes to Alcohol Use Disorder (AUD). Globally, more than 5% of all illness and injury are attributable to AUD. Treatment is challenging; 47-75% of AUD patients who are clinically detoxified relapse within one year. Recovry aims to prevent an unhealthy lifestyle due to (alcohol) addiction by developing and testing a Virtual Reality (VR) self-prevention tool (relocating and replacing care treatment). Although research shows that VR is used successfully in health care and in the treatment of alcohol addiction, especially through the creation of presence, it has not been tested for effectiveness and implementation (as an adjuvant in a clinical post-detoxification phase of an AUD- therapy). The question of whether virtual-humans should be used in a VR treatment and whether 3600 recorded VR or computer generated (CG) VR should be selected before. The use of a virtual human in VR has expected advantages (more effect) but also disadvantages (more costs). The expected advantages and disadvantages of 360o VR (cheaper, faster, more personal) and CG VR (more flexible and interactive) also cause choice and implementation problems. Recovry is the first project in which a VR tool is (further) developed in which an AUD treatment can (and will) be tested for the effect and effectiveness of adding virtual humans in CG and 360o VR environments as part of preventive care for patients with an AUD. This project thus serves as a prelude to cooperation in the Netherlands around a more effective implementation of VR in the (self) care system and thus the active and independent integration of former AUD patients in society (“more people, less patients”).
