Intervention Approaches for Osteoarthritis

Abstract

Osteoarthritis (OA) currently affects 32.5 million people in the United States at a cost of $136.8 billion. The available literature on the epidemiology of OA shows that the number of people affected will increase exponentially by the year 2040, affecting 78.4 million people. There is an abundance of evidence that self-management and physical activity (PA) approaches improve multiple outcomes for individuals with arthritis. However, these programs are not widely accessible to the population that can benefit from them across the United States. Two national organizations—the arthritis program of the Centers for Disease Control and Prevention (CDC) and the Administration on Community Living (ACL)—have established similar, but distinct, criteria for the review of evidence-based programs and seek to promote their dissemination. The CDC arthritis program has reviewed the evidence bases of arthritis-appropriate, evidence-based intervention programs and classified them as self-management or PA approaches. These “recognized” programs are recommended for national dissemination by the CDC. The ACL has also recognized several of the same programs by using its own criteria and classified them as Self-Management or Falls Prevention approaches. The different review criteria used by these two national public organizations present significant challenges for investigators who design interventions. The situation is further compounded by an investment in funding that hugely supports the discovery of interventions as opposed to the dissemination of interventions that have demonstrated efficacy. The National Public Health Agenda for Osteoarthritis: 2020 Update presents a blueprint that includes nine strategies for improving public health outcomes among persons with OA. These recommendations should be considered by interventionists in the future when developing programs. Other areas that can substantially benefit from further research include weight management and weight loss, injury prevention, technology-based interventions, addressing comorbid conditions, and understanding program mechanisms of action. Finally, underscoring all of these approaches and common to them is the need to enroll underserved populations to improve health equity. Underserved populations disproportionately include African Americans, Hispanics, persons with low socioeconomic status, and persons who live in rural areas of the United States. Policy recommendations to render future approaches to improving health outcomes for persons with OA are (a) to increase funding for the dissemination of programs that demonstrated efficacy and effectiveness, (b) to increase the transparency of the review and funding processes across public agencies, and (c) to nurture, broker, and provide sustainable funding streams to maintain evidence-based programming for all persons with OA across the United States.