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).
Personalization, production on-demand, and flexible manufacture facilities are growing within the European apparel sector, supported by national and regional public policy. These developments seem to embody a much waited “paradigm shift” in the fashion industry; a shift from global to local scale, from quantity to quality and from standard products to personalized services. Such values, however, are far from new, and scholars have already pointed out the similarities between emerging and pre-industrial systems of production and consumption. This article argues that in order to understand current developments in historical context, we should return to the process of industrialization of the apparel industry during the turn from the 19th to the 20th C, taking into account aspects of production as much as mediation and consumption. With this aim in mind, the article traces the rise of ready-made garments in the Netherlands and northwest Europe, and the associated decline in custom- and home-made garments in the region. Although available statistical data is insufficient to accurately map these phenomena, secondary sources suggest that both processes were not simultaneous and therefore there was not a straightforward substitution of custom- and home-made clothing by ready-mades. While availability and trade of mass-produced ready-mades was escalating since the early 19th C, it was not until mid 20th C that custom- and home-made clothing declined among the middle class. In this study, such a gap is explained by a steady increase in the amount of clothes acquired per person: an expanding culture of consumption during the period under consideration may have enabled these different systems to flourish all together. A parallelism of the findings above with current developments suggests that we should not regard emergent industrial formats as substitutionary of established ones, but as complementary. We may then reevaluate to what extent does the rise of the flexible factory enable a “revolution”, a shift from a problematic present to a contrasting and desirable future. This historical overview indicates that, on the contrary, emerging product-service-systems manufacturing personalized garments on-demand must be considered in relation to – and in coexistence with- traditional industrial models.
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