Abstract
Objectives:The Cycling against Hip Pain programme is a 6-week exercise and education treatment pathway for people with hip osteoarthritis. Preliminary results of the Cycling against Hip Pain programme found significant improvements in clinical and patient-reported outcome measures for patients referred from primary care. This article evaluates the effectiveness of the changes made to the pathway in a quality improvement replication programme.Methods:The replicated Cycling against Hip Pain programme was delivered between February 2018 and September 2019 in a region of England with a high percentage of adults aged over 65 years. All participants were referred from the orthopaedic outpatient department of the funding hospital (secondary care). The programme was delivered at a local leisure centre and combined 30 min of education on osteoarthritis with 30 min of progressive static cycling, once a week for 6 weeks.Results:The participants on the replicated Cycling against Hip Pain programme did not differ from the original cohort in terms of age or pre-programme weight, however, presented with worse hip symptoms at baseline. Consistent with the findings from the original cohort, participants demonstrated significant improvements to their Oxford Hip Score, 30-s chair stand performance, Timed Up and Go score, Hip Osteoarthritis Outcome Score function and pain, EQ5D health rating, EQ5D-5L score and pain at rest and on weight bearing. In addition, participants reported an increase in knowledge, confidence and motivation to exercise.Conclusion:A 6-week cycling and education intervention for the treatment of hip osteoarthritis provided benefits to function, pain and quality of life for patients referred from secondary care. These results are consistent with findings from patients who were referred from primary care and further support the potential of the pathway in the conservative management of hip osteoarthritis.
Highlights
Osteoarthritis is a common musculoskeletal condition within older adults, with an estimated 33% of people aged 45 and over (8.75 million) having sought treatment for the disease in the United Kingdom.[1]
As all referrals were direct from an orthopaedic outpatient department in secondary care, it was predicted that participants may have more severe osteoarthritis, and so may have worse symptoms, such as pain, function or stiffness,[24] when compared to the original cohort.[15]
The mean baseline Oxford Hip Score was 29.17 and 141 (84%) participants had a diagnosis of hip osteoarthritis
Summary
Osteoarthritis is a common musculoskeletal condition within older adults, with an estimated 33% of people aged 45 and over (8.75 million) having sought treatment for the disease in the United Kingdom.[1] Almost two and a half million adults (10.9%) aged over 45 have osteoarthritis of the hip, which can cause debilitating pain leading to referral for total hip replacement surgery.[2] While this procedure is clinically effective[3,4,5] and cost-efficient,[6] surgery presents major risks and complications such as dislocation, blood clots and infection.[7] Encouraging patients to self-manage their symptoms in the earlier stages of the disease process may have a longer term benefit. Self-management, exercise (aerobic and local muscle strengthening) and weight loss where appropriate as conservative treatment for osteoarthritis. The research evidence summarising the benefits of exercise for the self-management of hip osteoarthritis is expanding;[10,11,12,13] the optimal form and dose of exercise has not yet been elucidated.[11,14]
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