This study compared the clinical effectiveness and cost-utility of a 12-week home-based digital exercise programme versus 12-week hospital-supervised physiotherapy for adults with plantar fasciitis managed in routine Chinese tertiary-hospital care. The primary clinical aim was to assess non-inferiority for 3-month first-step morning pain. The economic aim was a 12-month cost-utility analysis from both payer and societal perspectives.
The investigation was a single-centre retrospective cohort study employing 1:2 propensity-score matching. Matching used 13 baseline covariates to reduce confounding in this observational dataset. The study population comprised patients treated between 2022 and 2024. The report includes both clinical and economic analyses.
A total of 587 adults with clinician-confirmed plantar fasciitis were matched for analysis. The authors report that only 6.3% of screened patients met the eligibility criteria used for matching, indicating a narrow analytic sample relative to the screened population.
Two treatment strategies were compared:
The study contrasted these real-world care pathways as delivered in routine tertiary-hospital practice.
The primary outcome was first-step morning pain at 3 months, measured on a 0–10 numeric rating scale. The prespecified primary non-inferiority margin was 1.3 points. Two sensitivity non-inferiority margins were also defined at 0.9 and 1.9 points. A 12-month cost-utility analysis reported incremental costs and incremental quality-adjusted life-years (QALYs).
The analysis used 1:2 propensity-score matching on 13 baseline covariates to create comparable treatment groups. Effect estimates for the primary clinical outcome were adjusted; the abstract reports an adjusted mean difference with confidence intervals and a p value. An E-value was provided to quantify the robustness of the observed association to unmeasured confounding. Cost-utility results were evaluated using bootstrap replications to assess uncertainty in dominance and cost-effectiveness.
For the primary outcome of first-step morning pain at 3 months, the adjusted mean difference between home-based digital exercise and hospital physiotherapy was −0.63 points (95% confidence interval −0.92 to −0.35; p < 0.001). This difference met non-inferiority against the primary margin of 1.3 points and both sensitivity margins (0.9 and 1.9). The reported E-value was 2.84, indicating the minimum strength of association an unmeasured confounder would need with both exposure and outcome to explain away the observed effect estimate.
The 12-month cost-utility analysis showed cost savings and a small QALY gain favoring the home-based digital exercise arm. Incremental payer cost was −¥4,920 (reported conversion −US$684), and incremental societal cost was −¥7,008 (−US$974). Incremental QALYs were +0.011. In probabilistic analysis, the home-based digital exercise strategy dominated (lower cost and greater QALYs) in 96.7% of bootstrap replications.
Several important limitations are reported in the abstract and should temper interpretation:
Because these limitations remain, the authors caution that the observational findings are provisional.
In this propensity-score-matched retrospective cohort, a 12-week home-based digital exercise programme was non-inferior to 12-week hospital-supervised physiotherapy for first-step morning pain at 3 months and was less costly from both payer and societal perspectives over 12 months, with a small QALY gain and dominance in most bootstrap replications.
However, the study’s residual confounding, imbalanced covariates after matching, and narrow eligible fraction mean these results cannot definitively establish equivalence or superiority. The authors explicitly state that these observational results require confirmation in a pragmatic multicentre randomized controlled trial before they should be used to inform reimbursement decisions or policy changes.
Clinicians and policymakers should interpret the reported clinical and economic advantages as hypothesis-generating. Future randomized effectiveness and implementation trials should report detailed intervention components, adherence, and broader patient eligibility to establish generalizability and causal effects prior to widespread adoption or reimbursement changes.