Einfluss einer zweitägigen Schulung auf das Wissen und die Sicherheit deutscher Physiotherapeut*innen in der Versorgung von Hüft- und Kniegelenksarthrose

To identify contextual factors that modify the treatment effect of the 'Good Life with osteoArthritis in Denmark' (GLAD) exercise and education programme compared to open-label placebo (OLP) on knee pain in individuals with knee osteoarthritis (OA). Secondary effect modifier analysis of a randomised controlled trial. 206 participants with symptomatic and radiographic knee OA were randomised to either the 8-week GLAD programme (n=102) or OLP given as 4 intra-articular saline injections over 8 weeks (n=104). The primary outcome was change from baseline to week 9 in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale (range 0 (worst) to 100 (best)). Subgroups were created based on baseline information: BMI, swollen study knee, bilateral radiographic knee OA, sports participation as a young adult, sex, median age, a priori treatment preference, regular use of analgesics (NSAIDs or paracetamol), radiographic disease severity, and presence of constant or intermittent pain. Participants who reported use of analgesics at baseline seem to benefit from the GLAD programme over OLP (subgroup contrast: 10.3 KOOS pain points (95% CI 3.0 to 17.6)). Participants with constant pain at baseline also seem to benefit from GLAD over OLP (subgroup contrast: 10.0 points (95% CI 2.8 to 17.2)). These results imply that patients who take analgesics or report constant knee pain, GLAD seems to yield clinically relevant benefits on knee pain when compared to OLP. The results support a stratified recommendation of GLAD as management of knee OA. ClinicalTrials.gov Identifier: NCT03843931. EudraCT number 2019-000809-71.

BackgroundThe guideline-based, conservative, non-pharmacological management of hip and knee osteoarthritis in clinical practice has been insufficient in Switzerland until now. The implementation of “Good Life with Osteoarthritis in Denmark” (GLA:D®), a programme designed to address this evidence-performance gap, was started in 2019 in Switzerland. This study investigated the acceptance and practicality of the GLA:D® Switzerland programme and identified the facilitators and barriers to its implementation, to support the development of tailored implementation strategies.MethodsThis is a non-experimental observational study. A cross-sectional survey was performed among the physiotherapists (PTs) of the first five GLA:D® Switzerland certification courses, using the Measurement Instrument for Determinants of Innovations (MIDI) to identify the facilitators and barriers. Descriptive statistics were calculated, and qualitative content analysis was used for open-ended questions.ResultsIn the online survey, 86 GLA:D® certified PTs participated (response rate: 61%). The majority of 51 PTs (63.7%) worked in private practices. Of the responding PTs 58 (78.4%) were satisfied with the general concept of the GLA:D® Switzerland programme. Practicality was evaluated positively, particularly the second and third individual session (n = 40 PTs, 83.3%), the 40 m Fast-paced Walk Test (43, 89.6%), the 30 s Chair Stand Test (45, 93.8%), and the exercise programme (40, 83.3%). The marketing (12, 15%), the ‘data entry’ (5, 10.4%), ‘register the patient’ (7, 14.6%), and the digital patient questionnaire (9, 14.2%) were rated less positively. In total, 12 facilitators and 12 barriers were identified. The barriers were mainly related to adopting user, e.g., perceived personal disadvantages. Barriers were also found in the organisational context, e.g., time available. Facilitators were associated with the GLA:D® Switzerland programme itself, e.g., completeness, relevance for patients, and the adopting user, e.g., self-efficacy, and in the organisational context, e.g., material resources and facilities. Topics related to the socio-political context were raised in the answers to the open-ended questions, e.g., general awareness level of the GLA:D® Switzerland programme and patient recruitment.ConclusionThe acceptance, practicality and facilitators identified from the initial implementation are encouraging. However, the identified barriers and activities rated with low practicality require tailored strategies to support a successful implementation of the GLA:D® Switzerland programme.

BackgroundThe uptake of evidence-based guidelines in clinical practice is suboptimal in osteoarthritis (OA) and other chronic diseases. Good Life with osteoArthritis in Denmark (GLA:D) was launched in 2013 with the aim of implementing guidelines for the treatment of knee and hip OA in clinical care nationwide. The purpose of this report was to evaluate the effects of the GLA:D intervention from 2013 to 2015, using data from the national GLA:D registry.MethodsPatients undergo education and supervised exercise delivered by trained physiotherapists. Outcomes evaluated at baseline, 3 and 12 months are pain intensity (0 to 100, best to worst), objective physical function (30-s chair-stand test and 40-m fast-paced walk test), physical activity (number of days per week being physically active for at least 30 min), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) quality of life subscale, 0–100, worst to best), number of patients on painkillers and sick leave, and access to care according to guidelines.ResultsData from 9,825 participants from the GLA:D registry were utilised in the analyses. It was demonstrated that GLA:D improved pain intensity and quality of life by 12.4 points and 5.4 points at 3 months, and 13.7 points and 9.4 points at 12 months, respectively. Furthermore, physical function and physical activity improved (only at 3 months), fewer patients took painkillers following the treatment, and fewer patients were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D. GLA:D is offered in all five health care regions in Denmark via 286 active GLA:D units, but the uptake in the Danish municipalities is still low with only 20% of the municipalities offering GLA:D.ConclusionThree years after its inception, GLA:D has been rolled out nationwide and has a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave. The lifestyle changes introduced by education and supervised exercise were largely maintained at 1 year and may have the potential to also improve general health and reduce societal costs.

A mixed methods study of knee confidence and self-efficacy: perceptions of knee osteoarthritis patients from the good life with osteoarthritis in Denmark initiative

Individualized predictions of changes in knee pain, quality of life and walking speed following patient education and exercise therapy in patients with knee osteoarthritis – a prognostic model study

ObjectivesTo evaluate 1-year cost-effectiveness of an 8-week supervised education and exercise programme delivered in primary care to patients with symptomatic knee or hip osteoarthritis (OA).DesignA registry-based pre–post study linking patient-level...

To assess the difference in prevalence of sleep problems and insomnia in patients with knee or hip osteoarthritis (OA), and explore characteristics associated with sleep problems and insomnia. We included 8,162 knee/hip OA patients enrolled in supervised exercise and patient education through the Good Life with osteoArthritis in Denmark (GLA:D®) program. We assessed presence of sleep problems (yes/no), followed by the Insomnia Severity Index 3-item (ISI-3) questionnaire among those with sleep problems (Insomnia: ISI-3 score ≥ 7). Characteristics associated with sleep problems/insomnia was estimated for knee and hip OA patients separately (prevalence ratios [PR]). In total, 68% (n = 3,539) and 64% (n = 1,807) of knee and hip OA patients reported sleep problems, respectively, corresponding to a PR of 1.06 (95% CI 1.03 to 1.10). Prevalence of insomnia was 17% (n = 943) and 20% (n = 528) for those with knee and hip OA, respectively (PR 1.18 [95% CI 1.07 to 1.30]). Large overlap between characteristics associated with sleep problems and insomnia were observed. Characteristics most strongly associated with higher prevalence of insomnia were pain intensity ≥40 mm VAS (knee: PR 2.39 [95% CI 2.08 to 2.74]; hip: PR 2.54 [95% CI 2.10 to 3.07], a high number of comorbidities, and analgesic use in both patients with knee and hip OA. Sleep problems and insomnia are highly prevalent among primary care patients with knee and hip OA, and slightly more common in hip OA patients. Prevalence of insomnia was substantially higher among patients with more comorbidities, higher pain intensity and analgesic use.

BackgroundPrevious studies have found that lumbar spinal stenosis (LSS) often co-occurs with knee or hip OA and can impact treatment response. However, it is unclear what participant characteristics may be helpful in identifying individuals with these co-occurring conditions. The aim of this cross-sectional study was to explore characteristics associated with comorbid symptoms of lumbar spinal stenosis (LSS) in people with knee or hip osteoarthritis (OA) enrolled in a primary care education and exercise program.MethodsSociodemographic, clinical characteristics, health status measures, and a self-report questionnaire on the presence of LSS symptoms was collected at baseline from the Good Life with osteoArthritis in Denmark primary care program for knee and hip OA. Cross-sectional associations between characteristics and the presence of comorbid LSS symptoms were assessed separately in participants with primary complaint of knee and hip OA, using domain-specific logistic models and a logistic model including all characteristics.ResultsA total of 6,541 participants with a primary complaint of knee OA and 2,595 participants with a primary complaint of hip OA were included, of which 40% and 50% reported comorbid LSS symptoms, respectively. LSS symptoms were associated with similar characteristics in knee and hip OA. Sick leave was the only sociodemographic variable consistently associated with LSS symptoms. For clinical characteristics, back pain, longer symptom duration and bilateral or comorbid knee or hip symptoms were also consistently associated. Health status measures were not consistently related to LSS symptoms.ConclusionComorbid LSS symptoms in people with knee or hip OA undergoing a primary care treatment program of group-based education and exercise were common and associated with a similar set of characteristics. These characteristics may help to identify people with co-occurring LSS and knee or hip OA, which can be used to help guide clinical decision-making.

Implementation of good life with osteoarthritis in denmark (GLA:D®) is feasible in australian tertiary public hospital facilities

WHO ARE LIKELY TO BENEFIT FROM THE GOOD LIFE WITH OSTEOARTHRITIS IN DENMARK (GLAD) EXERCISE AND EDUCATION PROGRAM? AN EFFECT MODIFIER ANALYSIS FROM A RANDOMIZED TRIAL

Good Life with osteoArthritis in Denmark (GLA:D®) is a program for the management of patients with hip and knee osteoarthritis (OA). Adapted for the Canadian population, the GLA:DTM Canada program implements evidence-based strategies to support the prevention, early diagnosis and effective management of hip and knee OA. GLA:D assists local communities in implementing OA strategies across the spectrum of disease severity. An integral part of this program is a national quality and outcomes registry, which includes data concerning participant characteristics and both patient-reported and functional outcomes. This registry helps healthcare providers and healthcare decision makers ensure that individuals with OA receive effective, high-quality care through the GLA:D Canada program.

Cross-cultural adaptation and implementation of Good Life with osteoarthritis in Denmark (GLA:D™): group education and exercise for hip and knee osteoarthritis is feasible in Canada.

In this issue of The Journal of Rheumatology, the article by King et al describes a registry-based cohort study of the Good Life With Osteoarthritis in Denmark (GLA:D) 8-week education and exercise program.1 Rather than focusing on knee pain, the authors examined change in self-reported difficulty walking, a primary reason people with knee osteoarthritis (OA) seek care, and assessed patient factors associated with improvement in difficulty walking after the program.

ObjectiveTo investigate whether adults with potential multiple social disadvantage have poorer outcomes following attendance in an osteoarthritis (OA) management program (OAMP), and if so, what might determine this result.MethodsAmong consecutive knee OA attendees of the Good Life With Osteoarthritis in Denmark (GLA:D) OAMP in Denmark we defined a group with potential “intersectional disadvantage” based on self‐reported educational attainment, country of birth, and citizenship. Outcomes of this group were compared with GLA:D participants who were native Danish citizens with higher educational attainment. Outcomes were pain intensity, Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale score, and the EuroQol 5‐domain instrument in 5 levels (EQ‐5D‐5L) score at 3 and 12 months. After data preprocessing, we used entropy balancing to sequentially control for differences between the groups in baseline covariates. Mean between‐group differences in outcomes were estimated by weighted linear regression.ResultsOf 18,448 eligible participants, 250 (1.4%) were nonnative/foreign citizens with lower education. After balancing for differences in baseline score and in administrative and demographic characteristics, they had poorer outcomes than higher‐educated native Danish citizens on pain intensity and EQ‐5D‐5L score at both follow‐up points (e.g., between‐group mean differences in pain visual analog scale [0–100] at 3 and 12 months: 3.4 [95% confidence interval (95% CI) –0.5, 7.3] and 6.2 [95% CI 1.7, 10.7], respectively). Differences in KOOS quality of life subscale score, were smaller or absent. Balancing for differences on baseline score, comorbidity, self‐efficacy, and depression had the greatest effect on reducing observed outcome inequalities.ConclusionOutcome inequalities widened following OAMP attendance, particularly at longer‐term follow‐up, but the magnitude of differences was generally modest and inconsistent across outcome measures. Tailoring content to reduce outcome inequalities may be indicated, but improving access appears the greater priority.

Barriers and enablers to uptake of a contemporary guideline-based management program for hip and knee osteoarthritis: A qualitative study