Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial

• DOI: 10.1371/journal.pmed.1002949
• Publication Date: 2019-10-15T18:39:05Z
• Authors: Nina Østerås; Tuva Moseng; Leti van Bodegom-Vos; Krysia Dziedzic; Ibrahim Mdala; Bård Natvig; Jan Harald Røtterud; Unni-Berit Schjer...; Thea Vliet Vlieland; Øyvor Andreassen; Jorun Nystuen Hansen; Kåre Birger Hagen
• Keywords: Adult; Male; Health Personnel; 610; Osteoarthritis, Hip; 03 medical and health sciences; 0302 clinical medicine; RC925; General Practitioners; Cluster Analysis; Humans; Program Development; Referral and Consultation; Physical Therapy Modalities; Aged; 2. Zero hunger; Primary Health Care; Norway; R; Middle Aged; Osteoarthritis, Knee; 16. Peace & justice; Hospitals; 3. Good health; Patient Satisfaction; Medicine; Female; Self Report; Patient Participation; Research Article

To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model integrated OA was developed based on international recommendations. The objective this study to assess the effectiveness in primary care.We conducted cluster-randomised controlled trial stepped-wedge cohort design 6 Norwegian municipalities (clusters) between January 2015 October 2017. randomised order concealed clusters until time crossover from control intervention phase. implementation SAMBA model, facilitated by interactive workshops general practitioners physiotherapists an update treatment Patients group attended physiotherapist-led education individually tailored exercise programme 8-12 weeks. outcome patient-reported (OsteoArthritis Quality Indicator questionnaire; 0-100, 100 = optimal quality) at months. Secondary outcomes included referrals physiotherapy, magnetic resonance imaging (MRI), orthopaedic surgeon consultation; patients' satisfaction care; physical activity level; proportion who were overweight or obese (body mass index ≥ 25 kg/m2). In all, 40 80 (mean age [SD] 50 [12] years, 42% females) 37 64 42 [8] 65% participated. They identified 531 patients, which 393 [10] 71% symptomatic included. Among these, 109 recruited during periods (control group), 284 interventions (intervention group). reported significantly higher (score 60 versus 41, mean difference 18.9; 95% CI 12.7, 25.1; p < 0.001) (odds ratio [OR] 12.1; 6.44, 22.72; compared group. increase close to, but below, pre-specified minimal important change. group, referred physiotherapy (OR 2.5; 1.08, 5.73; 0.03), fulfilled recommendations 9.3; 2.87, 30.37; 0.001), lower 0.3; 0.08, 0.80; 0.02), as There no significant differences regarding referral MRI 0.6; 0.13, 2.38; 0.42) 1.3; 0.70, 2.51; 0.34). Study limitations include imbalance patient size, may have been due increased attention among health professionals phase, potential recruitment bias participants their professionals.In study, resulted usual care. Future studies should explore ways implement larger scale.ClinicalTrials.gov NCT02333656.