HIGHER QUALITY OF CARE AND LESS SURGERY AFTER IMPLEMENTING OSTEOARTHRITIS GUIDELINES IN PRIMARY CARE - LONG-TERM RESULTS FROM A CLUSTER RANDOMIZED CONTROLLED TRIAL
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Previous research has revealed that people with hip and knee osteoarthritis (OA) do not often receive best practice treatment modalities. To improve the provision of recommended treatment for people with hip and knee OA, a model for care for OA was developed.
The model was implemented among general practitioners (GPs) and physiotherapists (PTs) in primary care in six Norwegian municipalities. The main components of the model were a patient education programme, followed by 8-12 weeks of individually tailored, supervised exercise.
One hundred GPs and 64 PTs were invited to participate in workshops to get an update on current treatment recommendations and the model of OA care. Forty GPs and 37 PTs attended.
A total of 393 patients aged 45 years or older with OA-related pain from their hip or knee participated in the study. Two-hundred and eighty-four of these received the new model for OA care while 109 received standard care. In the OA model group, 92% of the patients attended the OA education programme and 64% completed 8 weeks or more of exercise.
After 6 months, patient-reported quality of care and satisfaction with care were greater in the OA model group compared to the standard group. More patients in the group receiving the OA model of care were also referred to physiotherapy and fewer to orthopaedic surgeon, and more patients fulfilled physical activity criteria compared to the standard care group.
The patients were reassessed after 12 months to investigate a potential long-term persistence in the beneficial effects of the model for OA. The results were similar to the six-month results with higher quality of care, patient satisfaction and physical activity levels in the group that received the model for OA care as opposed to standard care.
This means that the implementation of the model for OA care in primary health care can improve the provision of best practice for people with hip and knee OA. In addition, the results showed that fewer patients receiving the model of OA care underwent joint replacement surgery as compared to the standard care group.
This suggests that receiving best practice treatment for OA may reduce or postpone the need for surgery in people with hip or knee OA.
National Advisory Unit on Rehabilitation in Rheumatology
Division of Rheumatology and Research
Diakonhjemmet Hospital, Norway
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NINA ØSTERÅS
Assoc. Professor Physiotherapist PhD
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TUVA MOSENG
Researcher Physiotherapist PhD