Effectiveness and economic evaluation of therapeutic Nordic walking in patients with psychosomatic disorders: A pragmatic randomized controlled trial.

The effects of exercise therapy in patients with psychosomatic disorders are modest. Therapeutic Nordic walking (tNW) might be a clinically meaningful and cost-effective additional treatment modality. This study aimed to investigate the effects of a tNW program on improving coping ability, compared to the usual care in highly disabled patients with diverse psychosomatic disorders in a hospital setting, and the willingness-to-pay for this treatment modality. Primary outcomes were self-efficacy, readiness to change health behavior, physical performance and attitude to walking. Economic evaluation was conducted with the willingness-to-pay questionnaire. Cohens’ d and 95% confidence intervals were calculated for baseline, discharge and three month follow up using intention-to-treat analysis. Differences between groups were tested by t-test or nonparametric ANOVA. A total of 150 patients were included in this study. Results show no significant differences between the experimental and control group for any of the outcomes. Ratings of stages of change within the transtheoretical model were made by therapists or patients, they showed small effects within both groups (precontemplation: 0.2-0.4 points; preparation: 0.1-0.2; action: 0.4-1.1; maintenance: 0.4 for every comparison). There was no additional effect of the tNW program compared to the standard program in the outcome willingness-to-pay for tNW. However, since clinical experience and treatment expectancy of both patients and health care providers with this treatment modality play an important role in the treatment process, tNW might be a low-budget treatment option for some patients.