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More comprehensive strategies needed to improve osteoarthritis treatment

Combined patient and provider intervention does not statistically improve osteoarthritis outcomes compared with usual care, according to findings published in Annals of Internal Medicine.

“Most previous osteoarthritis interventions occurred at the patient level, with little attempt to effect provider- or system-level changes,” Kelli D. Allen, PhD, from Durham Veterans Affairs Medical Center and Duke University Medical Center, and colleagues wrote. “It is not known whether interventions focused on health care providers or patients may be more effective for improving osteoarthritis management and outcomes.”

The researchers assessed whether patient-based, provider-based and patient-provider interventions improved osteoarthritis outcome at 10 Duke University Health System community-based primary care clinics. In a cluster trial, they randomly assigned 537 outpatients with symptomatic hip or knee osteoarthritis to patient, provider or patient-provider interventions.

Allen and colleagues evaluated patient intervention via telephone, focusing on weight management, physical activity and cognitive behavioral pain management, and used linear mixed models to examine the difference in improvement among groups. They measured the total score at 12 months on the Western Ontario and McMaster Universities Osteoarthrosis Index (WOMAC).

The investigators found that patient and provider osteoarthritis interventions did not better outcomes beyond usual care. Compared with usual care, the results showed no difference in WOMAC score changes from baseline to 12 months in patient (–1.5 [95% CI, –5.1 to 2]; P = .4), provider (2.5 [CI, –0.9 to 5.9]; P = .152) or patient-provider (–0.7 [CI, –4.2 to 2.8]; P = .69) intervention groups. They also observed no changes in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. At 12 months, all groups saw improvements in WOMAC scores (range, –3.7 to –7.7).

These results contradict the findings of a previous study that found combined patient and provider intervention improved physical function in a group of patients with hip and knee osteoarthritis at a Department of Veterans Affairs medical center (VAMC).

“The overall effects in the VAMC study were modest, suggesting that for at least some patients, more intensive interventions may be needed to produce meaningful, sustained changes in osteoarthritis management and outcomes,” Allen and colleagues wrote. “Automated e-health interventions are a potential strategy for increasing intervention intensity in a scalable manner.” – by Savannah Demko

Disclosure: Allen reports primary funding for this study came from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Please see the full study for a list of all other researchers’ relevant financial disclosures.