Osteoarthritis Guidelines Research Articles

Use of non-drug non-operative interventions by community-dwelling people with hip and knee osteoarthritis

Purpose: Guidelines recommend non-drug non-surgical treatments as the first-line approach for hip and knee osteoarthritis (OA) management, and exercise is recommended by all clinical guidelines, irrespective of disease severity, pain levels and functional status. Yet there is limited data regarding use of these treatments by people with OA. This study analyzed the treatment usage patterns in older community-dwelling adults with hip or knee OA. The primary aim was to describe the patterns of use of non-drug non-operative interventions in the entire cohort, and to compare treatment use between people with hip and knee OA, in order to identify any evidence-practice gaps that may exist in the management of OA. Methods: Four cohorts who were recruited for, and enrolled in clinical trials, completed a survey at baseline assessment. This resulted in a convenience sample of 591 people with hip or knee OA. All participants completed a questionnaire indicating their past and/or current use of 17 non-drug, non-operative interventions each for their hip or knee OA. Each intervention was classified according to the American College of Rheumatology (ACR) clinical guideline recommendations as being “strongly recommended”, “conditionally recommended” or “no recommendation” for people with hip and/or knee OA to aid in interpretation of our findings. Descriptive analyses, based on frequency counts and proportions, and chi square tests described the use of each intervention in the total cohort, and within subgroups of knee and hip OA. Results: The most common strategy that participants reported having tried was making efforts to lose weight (n=367, 62% of the entire cohort). Of the other three interventions strongly recommended by the ACR less than half of the cohort reported having tried each (muscle strengthening= 44%, hydrotherapy= 21% and aerobic exercise= 21%). Of note, 46% of the cohort reported having tried stretching exercises, which has no recommendations from the ACR. Receiving counselling over the phone was the intervention least commonly tried by our cohort (<1%). Of the entire cohort 12% (n=71) had never used any of the 17 surveyed interventions. Fewer people with hip OA had tried conservative non-drug treatments for their condition compared to those with knee OA. A significantly greater proportion of participants with knee OA reported having tried shoe orthoses (42% compared with 30% of hip OA); heat and/or cold treatment (43% versus 23%); muscle strengthening exercises (46% versus 32%); walking aids (15% versus 7%) and; transcutaneous electrical nerve stimulation (57% versus 4%). Conclusions: Use of non-drug non-operative interventions was low amongst people with hip and/or knee OA. In our sample, it appears that people with knee OA are more likely to try non-drug non-operative treatments than those with hip OA, however no explanation for this difference is obvious in this cohort. Our findings show evidence-practice gaps, particularly with respect to the interventions most strongly recommended in clinical guidelines for hip and knee OA (weight loss and exercise). Efforts to maximize the uptake of the strategies most strongly endorsed by research and guidelines are recommended.

OA trial bank

Purpose: Based on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA), and on the heterogeneity of OA patients, treatment guidelines for OA have stressed the need for research on clinical predictors of response to different treatments. Meta-analysis of individual patient data (IPD) of worldwide available RCTs would allow us to robustly identify subgroups that specifically response to certain treatment. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank, which is endorsed by the OARSI and the EULAR. The OA Trial Bank will bring together data from individuals with OA recruited to different clinical trials from different countries around the world to form a databank. Potential subgroups of patients for different interventions in OA patients will be predefined and will be analyzed with IPD. The procedures within the OA Trial Bank enable clinical OA researchers worldwide to initiate new research proposals and become involved in the OA Trial Bank. Methods: This workshop will inform about the OA Trial Bank organization, its legal procedures for data transfer, and the methods used for setting the objectives and performing data analyses. Secondly, the workshop will show an example based on the first IPD analyses from randomized trials studying the effect of intra-articular glucocorticoid injections in patients with hip or knee OA. Thirdly, by means of interactive procedures, subgroup identification for other interventions will be discussed and the workshop participants will learn how they can become involved in the OA Trail Bank.

Implementing osteoarthritis guidelines in UK primary care: Mosaics cluster randomised controlled trial

Purpose: Recommendations for osteoarthritis (OA) are not currently implemented in UK primary care. The MOSAICS study determined the clinical and cost effectiveness of a model OA consultation as a method of implementing core guideline recommendations for OA. Methods: Health survey; two arm cluster randomised controlled trial; 15,083 (53%) eligible responders 45 years and over from eight general practices; 525 patients consulting for peripheral joint pain during the 6m recruitment period of the cluster trial (4 intervention, 4 control practices). Intervention practices received practice updates on core OA recommendations (diagnosis; written information [patient generated OA guidebook], exercise and physical activity, healthy eating, pain management); General practitioners (GPs) received four hours of in¬practice training and simulated consultations on a model OA consultation; Practice Nurses received four days of education, workshops and training with simulated consultations for a model OA consultation; Participants randomised in the intervention arm received a consultation with the GP for joint pain, and as appropriate an OA guidebook and consultations for OA with a practice nurse (up to 4 visits). Clinical effectiveness was measured by the SF12 physical component score (primary outcome) at 6 months, OMERACT/OARSI responder criteria, joint pain intensity, pain self¬efficacy; Uptake of self-management measured by self¬reported Quality Indicators of OA care and patient enablement. Cost-consequence and cost utility analyses were also undertaken. Results: Mean (SD) practice size and number of GPs for intervention and control practices were 10240 (9174.8) & 6.0 (6.1) and 6983 (2060.7) & 5.2 (2.9) respectively. Of eligible participants, 288 were recruited from intervention practices and 237 from control practices. The mean age (SD) was 67.3 (10.5) and 59.6%, were Female. At three months self-reported consultations with a practice nurse for joint problems were n=70 (29%) in the intervention group compared with n=26 (13.5%) in the control arm. At six months there were no statistically significant differences in SFPCS, EQ5D or in other health outcomes between intervention and control, except for a borderline significant finding in reduction of knee pain intensity in the intervention arm compared with control (p=0.55). Uptake of self-management was statistically significantly greater (Odds Ratios) in the intervention arm compared with control for all core OA recommendations: provision of written information (e.g. exercise) (4.36, p< 0.001). Enablement mean (SD) scores were greater in the intervention arm compared with the control arm at 6 months and this was also statistically significant (3.21 (3.42) vs 2.28 (2.96), p=0.03). Visits to the orthopaedic surgeon were lower in the intervention arm compared with the usual care arm (p=0.02). Time off work and associated productivity cost were lower in the intervention arm. Conclusions: A model OA consultation can increase the uptake of OA recommendations in primary care but does not increase health status or quality of life. An integrated model with an emphasis on support for self¬management and lifestyle changes had a borderline significant impact on pain reduction in the knee. The model OA consultation also reduced uptake of NSAIDs and visits to an orthopaedic surgeon. Defining an integrated model consultation supported by training workshops can be an effective way of implementing clinical guidelines.

Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis

Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis

Use of nondrug, nonoperative interventions by community-dwelling people with hip and knee osteoarthritis.

Guidelines recommend nondrug, nonoperative treatments as the first-line approach for hip and knee osteoarthritis (OA), yet there is limited data regarding use of these treatments in OA. This study describes the use of nondrug, nonoperative interventions in people with hip and knee OA. A convenience sample of 591 people with hip or knee OA completed a questionnaire indicating their past and/or current use of 17 nondrug, nonoperative interventions each for their hip or knee OA. Descriptive analyses, based on frequency counts and proportions, and chi-square tests described the use of each intervention in the total cohort, and within subgroups of knee and hip OA. Participants were currently using a mean ± SD of 0.8 ± 0.9 of the strongly recommended interventions. Making efforts to lose weight (50%, n = 294) and shoe orthoses (30%, n = 175) were the most common currently used interventions. Strengthening (26%, n = 152) and stretching exercises (23%, n = 133) were the most common interventions that participants had tried in the past but were no longer utilizing. Of note, 12% (n = 71) had never used any of the interventions. Use of 5 treatments (shoe orthoses, heat and/or cold, muscle strengthening exercises, walking aids, and transcutaneous electrical nerve stimulation) was significantly different between the hip and knee cohorts (P < 0.05). Use of nondrug, nonoperative interventions was low among people with hip and knee OA. Our findings show evidence–practice gaps, particularly with respect to the interventions most strongly recommended in clinical guidelines for hip and knee OA (weight loss and exercise).

Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the Management of OsteoArthritis In Consultations (MOSAICS) study protocol.

BackgroundThere is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving ‘quality markers’ of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain.DesignA mixed methods study with a nested cluster randomised controlled trial.MethodThis study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive ‘whole-system’ evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations.DiscussionThe main output from the study will be to determine whether the MOAC intervention is clinically and cost effective. Additional outputs will be the development of the MOAC for patients consulting with joint pain in primary care, training and educational materials, and resources for patients and professionals regarding supported self-management and uptake of NICE guidance.Trial registrationISRCTN number: ISRCTN06984617.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0095-y) contains supplementary material, which is available to authorized users.

SAT0429 The OA TRIAL Bank: Meta-Analysis of Individual Patient Data Show That Patients with Severe Pain or with Inflammatory Signs Detected by Ultrasound Especially Benefit from Intra-Articular Glucocorticoids for Knee or Hip Oa

BackgroundBased on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA) and on the heterogeneity of OA patients, treatment guidelines for OA have stressed...

SAT0424 Barriers in Primary Care to Use Guidelines for Osteoarthritis of the Knee

BackgroundOsteoarthritis of the knee is a very common disease, and gains importance because of the aging population and the obesity epidemic1. Guidelines on the treatment and management of patients with...

Cost effectiveness of duloxetine for osteoarthritis: a Quebec societal perspective.

To assess the cost effectiveness of duloxetine compared to other oral postacetaminophen treatments for osteoarthritis (OA) from a Quebec societal perspective. A cost-utility analysis was performed enhancing the Markov model from the 2008 OA guidelines of the National Institute for Health and Clinical Excellence (NICE). The NICE model was extended to include opioid and antidepressant comparators, adding titration, discontinuation, and relevant adverse events (AEs). Comparators included duloxetine, celecoxib, diclofenac, naproxen, hydromorphone, and oxycodone extended release (oxycodone). AEs included gastrointestinal and cardiovascular events associated with nonsteroidal antiinflammatory drugs (NSAIDs), as well as fracture, opioid abuse, and constipation, among others. Costs and incremental cost-effectiveness ratios (ICERs) were estimated in 2011 Canadian dollars. The base case modeled a cohort of 55-year-old patients with OA for a 12-month period of treatment, followed by treatment from a basket of post-discontinuation oral therapies until death. Sensitivity analyses (one-way and probabilistic) were conducted. Overall, naproxen was the least expensive treatment, whereas oxycodone was the most expensive. Duloxetine accumulated the highest number of quality-adjusted life years (QALYs), with an ICER of $36,291 per QALY versus celecoxib. Duloxetine was dominant over opioids. In subgroup analyses, ICERs for duloxetine versus celecoxib were $15,619 and $20,463 for patients at high risk of NSAID-related AEs and patients ages >65 years, respectively. Duloxetine was cost effective for a cohort of 55-year-old patients with OA, and more so in older patients and those with greater AE risks.

Designing a strategy to implement optimal conservative treatments in patients with knee or hip osteoarthritis in orthopedic practice: a study protocol of the BART-OP study

BackgroundNational and international evidence-based guidelines for hip and knee osteoarthritis recommend to start with (a combination of) conservative treatments, followed by surgical intervention if a patient does not respond sufficiently to conservative treatment options. Despite these recommendations, there are strong indications that conservative treatments are not optimally used in orthopedic practice. Our study aims to quantify the use of conservative treatments in Dutch orthopedic practice and to explore the barriers and facilitators for the use of conservative treatments that should be taken into account in a strategy to improve the embedding of conservative treatments in hip and knee osteoarthritis in orthopedic practice.MethodsThis study consists of three phases. First, current use of conservative treatments in patients with hip and knee osteoarthritis will be explored using an internet-based survey among at least 100 patients to identify the underused conservative treatments. Second, barriers and facilitators for the use of conservative treatments in orthopedic practice will be identified using semi-structured interviews among 10 orthopedic surgeons and 5 patients. The interviews will be followed by an internet-based survey among approximately 450 orthopedic surgeons and at least 100 patients in which the identified barriers and facilitators will be ranked by importance. Finally, an implementation strategy will be developed based on the results of the previous phases using intervention mapping.DiscussionThe developed strategy is likely to result in an optimal and standardized use of conservative treatment options in hip and knee osteoarthritis in orthopedic practice, because it is focused on identified barriers and facilitators. In addition, the results of this study can be used as an example for optimizing the use of conservative care in other patient groups. In a subsequent study, the developed implementation strategy will be assessed on its effectiveness, feasibility and costs.

OARSI guidelines for the non-surgical management of knee osteoarthritis

To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OA literature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores. Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation). These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences.

Did the American Academy of Orthopaedic Surgeons Osteoarthritis Guidelines Miss the Mark?

The American Academy of Orthopaedic Surgeons (AAOS) 2013 guidelines for knee osteoarthritis recommended against the use of viscosupplementation for failing to meet the criterion of minimum clinically important improvement (MCII). However, the AAOS's methodology contained numerous flaws in obtaining, displaying, and interpreting MCII-based results. The current state of research on MCII allows it to be used only as a supplementary instrument, not a basis for clinical decision making. The AAOS guidelines should reflect this consideration in their recommendations to avoid condemning potentially viable treatments in the context of limited available alternatives.

Authors’ Reply to Liedgens and Henske: “Cost-Utility Analysis of Duloxetine in Osteoarthritis: A US Private Payer Perspective”

Thank you for giving us the opportunity to respond to the letter from Liedgens and Henske [1] concerning our costutility analysis of duloxetine in osteoarthritis (OA) [2]. Our analysis spanned multiple drug classes, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and an antidepressant. We were surprised by the reaction of Dr. Liedgens and Henske and are pleased to address their concerns. We do so below, using the same order and numbering as those used in their letter. 1) In their letter, Liedgens and Henske focus on pain levels. The basis of the treatment-specific utilities in our model was Western Ontario and McMaster Universities Arthritis Index (WOMAC) total scores, not exclusively pain scores. Total WOMAC scores incorporate function and stiffness, as well as pain. WOMAC scores have been mapped to health-related quality of life utilities by several studies [3–5] and have been used in pharmacoeconomic models such as that produced for the UK National Institute for Health and Clinical Excellence OA guideline [6]. The inclusion criteria for nearly all OA trials, regardless of treatment, specify pain of at least 4 on a 0–10 scale, i.e. at least moderate pain. Moreover, tapentadol trials have not reported baseline WOMAC scores, so there is no basis to assume that the severity of OA in those trials was greater than that in trials of other treatments. We believe that the continuum of treatments from NSAIDs to opioids represent relevant comparators to duloxetine and therefore they are appropriately represented in our analysis. 2) Liedgens and Henske note that our article did not make it clear which formulation of tapentadol was being compared. We concede that we could have been more specific; however, the assumptions we made for tapentadol were not made to enhance the position of duloxetine, but were made because of the unclear reporting of WOMAC scores in tapentadol trials (see response #9 below) and to be conservative in our estimation of the cost of tapentadol. The makers of tapentadol have conducted clinical trials of both immediate release (IR) [7] and extended release (ER) [8–10] formulations of tapentadol in OA populations. To be conservative in our analysis, the tapentadol IR formulation was used for costing because it is cheaper in the USA. Therefore, tapentadol IR dosing was also used. 3) Liedgens and Henske incorrectly state that an oxycodone daily dose of 10–30 mg was used in our model. The model’s dosage was 10–30 mg twice daily (see Table 1 in our article) [2]. The range of tapentadol dosing in the model was the same as that in the tapentadol IR study conducted by Hale et al. [7]. The average tapentadol IR daily dose used in the model was 450 mg, not the 600 mg stated by Liedgens and Henske. 4) Liedgens and Henske incorrectly state that the utility for tapentadol in our model was the same as that for tramadol. In fact, tapentadol was assigned the same utility as oxycodone—the highest efficacy-based, treatment-specific utility assigned in the model (see Table 1 in our article). In addition, the initial 3-month discontinuation rates for tapentadol IR and ER are very similar (44.0 % for tapentadol ER in the analysis performed by Lange et al. [11] This reply refers to the article available at doi:10.1007/s40258-0130031-3 and doi:10.1007/s40258-013-0048-7.

Recent changes in evidence-based, non-pharmacological treatment recommendations for acupuncture and Tai Chi for knee osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. The knee and hip joints are the most common sites for OA, and knee OA is more prevalent than hip OA. Knee OA patients often suffer pain, functional disability, articular cartilage wear and related joint space narrowing. Among U.S. adults, 46.4 million have physician-diagnosed arthritis representing 21.6% of the U.S. population, and 8.3% (17.4 million) had activity limitations attributable to arthritis. It is estimated that by 2030, the number of physician-diagnosed arthritis cases will reach 67 million, and 25 million will have arthritisattributable activity limitations. Although 7.9% of U.S. adults aged 18e44 years have arthritis, this percentage increases to 29.3% and 50.0% for adults between 45 and 64 years and older than 65 years, respectively. Currently, there is no cure for this degenerative disease. The economic and functional impacts of this disease have become an increased burden for society and individuals. The treatment strategies for knee OA often are aimed at reducing pain, improving physical function, decreasing disability, and limiting OA progression. Over the two decades, several national and international medical organizations including the American College of Rheumatology (ACR), European League Against Rheumatology (EULAR), Osteoarthritis Research Society International (OARSI), and National Institute of Health (NIH) have published evidence-based guidelines for the management of knee OA. These guidelines are mostly evidence-based with expert consensus. The treatment recommendations from these guidelines include non-pharmacological and pharmacological therapies, intraarticular injections, and surgical procedures including arthroscopy, osteotomy and total/unicompartmental knee replacement. A combination of pharmacological and non-pharmacological treatments is commonly recommended in clinical practice and is universally recommended in existing guidelines for the management of knee OA. The non-pharmacological therapies commonly include patient education, selfmanagement programs, personalized social support through telephone contact, weight loss (if overweight), aerobic exercise programs, physical therapy, range-of-motion exercises, muscle strengthening, transcutaneous electrical nerve stimulation (TENS), electromagnetic field therapy (EFT), acupuncture, ultrasound, laser, spa, assistive devices for ambulation, patellar taping, the appropriate footwear, lateral-wedged insoles (for genu varum), bracing, occupational therapy, joint protection and energy conservation, and assistive devices for activities of daily living. In earlier guidelines, acupuncture, TENS, EFT, ultrasound, laser, bracing/taping, and footwear and orthotics were not usually recommended as non-pharmacological treatments. Among the non-pharmacological recommendations, patient education, muscle strengthening, aerobic and range of motion exercises and walking aids received the highest support. Chinese acupuncture as a knee OA treatment alternative first appeared in the knee OA guidelines in 2000 and since then, has been included inmore recent recommendations. In an earlier systematic review of OA, it was found that seven of the studies included reported positive results for acupuncture treatment, and six reported non-significant results. The NIH OA working group made the evidence-based conclusion that “the research to date on the efficacy of acupuncture in osteoarthritis is inconclusive but promising”. In a recentmeta-analysis of acupuncture for knee OA, patients receiving acupuncture showed short-term improvements in pain (effect size (ES) 1⁄4 0.96) and function (ES 1⁄4 0.93) as compared to patients in a waitlist control group. However, when compared to a sham control group, acupuncture showed diminished short-term effects on pain (ES1⁄4 0.35) and function (ES1⁄4 0.35). The ES for pain relief was further reduced at 6 months after treatment. In a more recent review of 16 qualified randomized control trials (RCT) for knee OA, it was shown that the external validity was inadequate in the E-mail address: szhang@utk.edu. Peer review under responsibility of Shanghai University of Sport

Individual patient data meta-analysis of trials investigating the effectiveness of intra-articular glucocorticoid injections in patients with knee or hip osteoarthritis: an OA Trial Bank protocol for a systematic review

BackgroundBased on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA), and on the heterogeneity of OA patients, treatment guidelines for OA have stressed the need for research on clinical predictors of response to different treatments. A meta-analysis to quantify the effect modified by the predictors using individual patient data (IPD) is suggested. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank. The study aims are therefore: to evaluate the efficacy of intra-articular glucocorticoids for knee or hip OA in specific subgroups of patients with severe pain and (mild) inflammatory signs, over both short-term and long-term follow-up, using IPD from existing studies; to reach consensus on the rules for cooperation in a consortium; and to develop and explore the methodological issues of meta-analysis with individual OA patient data.Methods/DesignFor the current IPD analysis we will collect and synthesize IPD from randomized trials studying the effect of intra-articular glucocorticoid injections in patients with hip or knee OA. Subgroup analyses will be performed for the primary outcome of pain at both short-term and long-term follow-up, in the subgroups of patients with and without severe pain and with and without inflammatory signs.DiscussionThis study protocol includes the first study of the OA Trial Bank, an international collaboration that initiates meta-analyses on predefined subgroups of OA patients from existing literature. This approach ensures a widely supported initiative and is therefore likely to be successful in data collection of existing trials. The collaboration developed (that is, the OA Trial Bank) may also lead to future IPD analyses on subgroups of patients with several intervention strategies applied in OA patients.

FRI0488-HPR Are occupational therapy interventions included in the most commonly used european clinical-practice guidelines for the management of osteoarthritis?

BackgroundThe EUMUSC.net project facilitates cooperation between EU Member States and promotes a comprehensive European strategy to optimise musculoskeletal health.ObjectivesPart of the EUMUSC.net project was devoted to retrieving clinical practice guidelines...

AB0599 The oa trial bank: individual patient data meta-analysis of trials investigating the effectiveness of intra-articular corticosteroid injections in patients with knee or hip oa

BackgroundBased on small to moderate effect size of the wide range of symptomatic treatments in osteoarthritis (OA), and the heterogeneity of OA patients, treatment guidelines for OA have stressed the...

SP0080 Self management in OA: Evidence for the role of the multidisciplinary team

Primary care, although varying between countries, is where most health care for osteoarthritis (OA) is provided in the context of peripheral joint pain in older adults. Education and self-management are...

OP0152-PC Knowledge and Confidence of Practice Nurses in the Management of Osteoarthritis (OA): Pre- and Post-Evaluation of an OA Self-Management Training Programme

BackgroundIn the United Kingdom (UK), practice nurses do not routinely consult with individuals with OA as most OA care is provided by general practitioners. However, evidence suggests that practice nurses...

OP0204-PC Multisite Peripheral Joint Pain in the Community: Prevalence and Impact in the North West Midlands, United Kingdom (UK)

BackgroundCurrent research and guidelines are often focused on single joint osteoarthritis (OA). The National Institute for Health and Clinical Excellence OA guidelines recommended that future research should consider the impact...