Abstract
We evaluated a structured education- and exercise-based self-management program for patients with knee or hip osteoarthritis (OA), using a registry-based study of data from 44,634 patients taken from the Swedish “Better Management of Patients with Osteoarthritis” registry. Outcome measures included a numeric rating scale (NRS), EuroQol five dimension scale (EQ-5D), Arthritis self-efficacy scale (ASES-pain and ASES-other symptoms), pain frequency, any use of OA medication, desire for surgery, fear–avoidance behavior, physical activity, and sick leave were reported at baseline, 3 and 12 month. Changes in scale variables were analyzed using general linear models for repeated measures and changes in binary variables by McNamara’s test. All analyses were stratified by joint. At the 3-month follow-up, patients with knee (n = 30686) and hip (n = 13948) OA reported significant improvements in the NRS-pain, the EQ-5D index, the ASES-other symptoms, and ASES-pain scores with standardized effect size (ES) ranges for patients with knee OA of 0.25–0.57 and hip OA of 0.15–0.39. Significantly fewer patients reported pain more than once weekly, took OA medication, desired surgery, showed fear–avoidance behavior, and were physically inactive. At the 12-month follow-up, patients with knee (n = 21647) and hip (n = 8898) OA reported significant improvements in NRS-pain, EQ-5D index, and a decrease in ASES-other symptoms and ASES-pain scores with an ES for patients with knee OA of –0.04 to 0.43 and hip OA of –0.18 to 0.22. Significantly fewer patients reported daily pain, desired surgery (for hip OA), reported fear–avoidance behavior, and reported sick leave. Following these interventions, patients with knee and hip OA experienced significant reductions in symptoms and decreased willingness to undergo surgery, while using less OA medication and taking less sick leave. The results indicate that offering this program as the first-line treatment for OA patients may reduce the burden of this disease.
Highlights
Osteoarthritis (OA) of the knee and hip is estimated as the 12th highest contributor to global disability [1]
A previous published systematic review have divided the barriers to the limited uptake of guidelines in clinical practice in four different themes; 1) “OA is not that serious” reflecting a belief that OA is a part of the normal aging, 2) Clinicians perceive they are underprepared to give health care according to guidelines, 3) “Personal beliefs at odds with providing recommended practice” and 4) “Dissonant patient expectations” [9]
All individuals included in the intervention group attended the theory component, and 86% of those with knee or hip OA received an individual adapted exercise program
Summary
Osteoarthritis (OA) of the knee and hip is estimated as the 12th highest contributor to global disability [1]. There is a discrepancy between recommended treatment and what patients receive. Less than 50% of people with OA seeking care receives the first line management [7, 8]. A previous published systematic review have divided the barriers to the limited uptake of guidelines in clinical practice in four different themes; 1) “OA is not that serious” reflecting a belief that OA is a part of the normal aging, 2) Clinicians perceive they are underprepared to give health care according to guidelines, 3) “Personal beliefs at odds with providing recommended practice” and 4) “Dissonant patient expectations” [9]
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