Clinical and Cost Effectiveness of Pre-Operative Physiotherapy for Patients Undergoing Anterior Cruciate Ligament Reconstruction in Riyadh, Saudi Arabia.

Purpose: To examine the clinical and cost effectiveness of a pre-operative physiotherapy programme for the management of Saudi patients with ACL injury. Methods: A pragmatic quasi-randomised controlled trial (RCT) was conducted to evaluate a newly developed pre-operative physiotherapy protocol. A total of 84 patients with ACL injury participated in the study; 45 in the Control group and 39 in the Intervention group (median age 27.5 years, IQR 8.5). The intervention protocol consisted of twelve 45-minute long sessions over 4 weeks and included 3 types of exercise: a warm-up session, muscle strengthening exercises and balance exercises. Measurements were taken upon enrollment and two weeks post-surgery. Outcomes included the knee injury and osteoarthritis outcome score (KOOS), ROM, muscle strength, pain, health state and quality of life (QoL). Cost-effectiveness of the intervention was examined using the incremental cost-effectiveness ratio (ICER) was used based on resource use and quality-adjusted life years (QALY). Data analysis described the measurements using medians and interquartile ranges (IQR) and assessed differences between the two groups using Mann-Whitney U-test. Results: Patients in the intervention group showed significant improvement in the primary outcomes compared to the control group as demonstrated by the KOOS scores (p < 0.001). Muscle strength was higher in the intervention group for both quadriceps and hamstring muscles (p < 0.01) with improvement in range of motion especially during flexion (p < 0.001). In addition, QoL was significantly better in the intervention group (p < 0.001). The measured ICER indicated that the intervention can be deemed to be cost-effective (£1150 per QALY gained). Conclusion(s): The present study suggests that a standardised pre-operative physiotherapy programme was clinically and cost effective for patients undergoing ACL reconstruction in KSA. Clinicians and decision makers are to be aware of these findings as they may provide justification for resource allocation in the management of patient with this condition. Implications: Based on the findings of the present study, pre-operative physiotherapy should be integrated into the Saudi healthcare system as a routine practice in hospitals and rehabilitation clinics. Based on the findings in relation to cost-effectiveness of the intervention in the present research, effectiveness of pre-operative physiotherapy in regards to the short term may potentially justify the resources that are required to implement it for use