Cycling and Education for Hip OA: A Cost-Effective Solution?

Medscape

a day ago

TOPLINE:
A cycling and education intervention significantly improved self-reported function in hip osteoarthritis (OA) compared with standard physiotherapy. The group-based intervention was also cost-effective, with a cost per quality-adjusted life year below the National Institute for Health and Care Excellence (NICE) threshold.
METHODOLOGY:
Researchers conducted a pragmatic randomized controlled trial comparing a group-based cycling and education intervention with usual physiotherapy care for hip OA (the CLEAT trial) in Bournemouth, UK.
A total of 221 patients (mean age, 64.4 years; 57% women; 98% White) with hip OA, as defined by NICE criteria, who met the primary care criteria for exercise referral were randomly assigned to either cycling against hip pain intervention (CHAIN, 110 participants) or usual physiotherapy care (111 participants).
Participants in the cycling group attended an 8-week program comprising education and static cycling sessions at a local leisure center, facilitated by a physiotherapist and a gym instructor, respectively. The physiotherapy group received usual one-to-one care, including exercise, education, and other physiotherapy techniques, at the local hospital or by telephone.
The primary outcome was the between-group difference in the self-reported function of performing everyday activities, measured using the Hip Disability and Osteoarthritis Outcome Score (HOOS) activities of daily living subscale at 10 weeks post-treatment.
The analysis included a parallel economic evaluation from the perspective of the UK National Health Service (NHS) and personal social services, assessing cost per quality-adjusted life year at 3 months after treatment.
TAKEAWAY:
Patients in the cycling group showed a significant improvement in the HOOS activities of daily living score at 10 weeks post-treatment compared with those in the physiotherapy group (adjusted mean difference, 6.9; P = .0023).
The cycling group experienced improvements in secondary outcomes, with significant increases in scores for symptoms and stiffness (P = .0072), sports (P = .022), and quality of life (P = .042), but no improvement in pain score.
No significant differences were observed in physiologic measures such as BMI, blood pressure, or resting heart rate between the cycling and physiotherapy groups.
The CHAIN intervention was cost-effective, with a base case analysis cost per quality-adjusted life year of £4092, and showed a high probability of cost-effectiveness at NICE thresholds compared with physiotherapy.
IN PRACTICE:
"Taken together, these findings add to a growing body of evidence suggesting that, although exercise is beneficial, between-group differences in function and pain are often small when comparing active interventions," the authors of the study wrote. "Although the study did not identify a clinically meaningful between-group difference, CHAIN's cost-effectiveness within the NHS positions it as a viable alternative to usual physiotherapy care," they added.
"From the patient's perspective, cycling combined with patient education offers a simple and accessible treatment approach," experts wrote in an accompanying comment. "From the perspective of decision makers, the group-based nature of CHAIN presents a highly cost-effective option for implementation in first-line treatment. Given that a single healthcare provider can deliver this intervention to many patients at a time, CHAIN provides scalability and resource efficiency, which are essential in publicly funded healthcare systems."
SOURCE:
The study was led by Thomas W. Wainwright, PhD, University Hospitals Dorset NHS Foundation Trust in Bournemouth, UK. It was published online on July 31, 2025, in The Lancet Rheumatology.
LIMITATIONS:
Most participants did not have radiographic confirmation of OA, affecting baseline severity assessment. The inability to mask participants and treatment providers introduces a risk of performance bias, potentially influencing self-reported outcomes. The exclusion of individuals unable to complete the exercise tolerance test limits applicability to those with lower fitness levels.
DISCLOSURES:
The study was supported by the Research for Patient Benefit Programme of the National Institute for Health and Care Research. One author disclosed receiving institutional research funding and personal fees, while another author reported receiving royalties and consulting fees from various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.