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Comparative effectiveness of international osteoarthritis management program clinical cohorts: a project of the oarsi joint effort initiative in collaboration with the OA trial bank

Purpose: There is growing international interest in the implementation of structured osteoarthritis management programs (OAMPs) to deliver best evidence osteoarthritis (OA) care. A consortium of researchers, clinicians and consumers concerned with optimising implementation of OAMPs have established the ‘Joint Effort’ Initiative (the Initiative), endorsed by the Osteoarthritis Research Society International (OARSI) in 2018. A priority action of the Initiative is to evaluate the outcomes and implementation of existing OAMPs.Marked differences between existing international OAMP models include treatments offered, settings and mode of delivery, intensity, duration and health disciplines involved. There is some evidence of effectiveness from randomised controlled trials (RCTs) and longitudinal cohort studies reporting outcomes from OAMPS in different real-world settings, however, this research is still in its infancy. The effects of different OAMP models have not been compared head-to-head and given the prohibitive costs and logistics associated with comparing OAMP models in RCTs, it is unlikely that these trials will take place. Instead, we will leverage research efforts and costs that have already been spent by combining data from existing cohort studies to compare the outcomes of different OAMP models.We aim to combine Individual Patient Data (IPD) from the existing international OAMP cohorts and use meta-analytic techniques to address the following objectives: 1) Compare the short-, medium- and long-term changes in pain, physical function, body weight, Quality of Life, fear of movement and goal achievement between different OAMPs. 2) Determine the short-, medium- and long-term overall effects of OAMPs on pain and physical function for people with knee and hip OA. 3) Examine the characteristics of OAMP participants who achieved/ did not achieve the Patient Acceptable Symptom State (PASS), OMERACT-OARSI responder criteria, and completers vs dropouts. 4) Describe the implementation evaluation outcomes of OAMPsMethods: We will use de-identified IPD from nine existing OAMP clinical cohorts from Australia, Norway, Sweden, Netherlands, UK, New Zealand and USA. Clinical cohorts will be eligible if they are derived from a hip/knee OAMP in a real-world setting with the following components: i) personalised OA care; ii) package of care with reassessment and progression; iii) minimum of two core treatments of education, exercise, and/or weight-loss, and; iv) optional adjunctive treatments. We will include both published and unpublished data.Based on scoping work on the outcomes measures and time points currently collected by each OAMP, our primary outcomes will be the difference in pain (numerical rating scale 0-10) and function (Western Ontario and McMasters Osteoarthritis Index function score (WOMAC)), at 12-weeks. Secondary outcomes will be changes in pain and function at 26- and 52-weeks. Other secondary outcomes at 12-, 26- and 52- weeks will be changes in: body weight; quality of life (EuroQol, Short Form 12); disease specific measures (Knee Injury and Osteoarthritis Outcome score, Hip Disability and Osteoarthritis Outcome score, WOMAC); functional performance (30-second chair stand test, six-minute walk test); fear of movement; and patient satisfaction. We will report against the PASS, OMERACT-OARSI definition of responders/non-responders and examine implementation outcomes where available including the Osteoarthritis Quality Indicator Questionnaire, uptake, reach and fidelity.The IPD will be harmonised and aggregated to create one large dataset. We will use descriptive statistics to compare the characteristics of participants across OAMPs. We will take a two-step approach to IPD meta-analytic techniques. First, we will estimate the change in outcomes for each OAMP (pain, function and other outcomes) with multivariable regression modelling. Second, we will weight and pool estimates using random-effects methods to determine the overall effects on pain and function, account for differences in effects across studies and examine prognostic effects and interactions of characteristics (e.g. baseline symptomatic severity, functional performance) of participants who achieved/did not achieve the PASS, OMERACT OARSI responder criteria and those who completed/dropped out of the OAMPs.Results: This study has received ethical approval from the NSLHD Human Research Ethics Committee (Australia). Ethical approval for use of other cohort data is being sought by researchers in their respective countries. We have performed extensive work with the stakeholders involved to identify appropriate co-collected outcomes and will collaborate with the OA Trial Bank to store and collate the cohort data, the first database of its kind.Conclusions: This project will be the first to compare patient and implementation outcomes across international OAMPs. It will address a priority of the Initiative and make recommendations on the “optimal” OAMP model/s to use.

Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both

Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. The design was a prospective, single-blind, multicenter, superiority, cluster-randomized controlled trial. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions.

Pain Coping and Healthcare Use in Patients with Early Knee and/or Hip Osteoarthritis

Background: Knee and hip osteoarthritis (OA) among older adults account for substantial disability and extensive healthcare use. Effective pain coping strategies help to deal with OA. This study aims to determine the long-term relationship between pain coping style and the course of healthcare use in patients with knee and/or hip OA over 10 years. Methods: Baseline and 10-year follow-up data of 861 Dutch participants with early knee and/or hip OA from the Cohort Hip and Cohort Knee (CHECK) cohort were used. The amount of healthcare use (HCU) and pain coping style were measured. Generalized Estimating Equations were used, adjusted for relevant confounders. Results: At baseline, 86.5% of the patients had an active pain coping style. Having an active pain coping style was significantly (p = 0.022) associated with an increase of 16.5% (95% CI, 2.0–32.7) in the number of used healthcare services over 10 years. Conclusion: Patients with early knee and/or hip OA with an active pain coping style use significantly more different healthcare services over 10 years, as opposed to those with a passive pain coping style. Further research should focus on altered treatment (e.g., focus on self-management) in patients with an active coping style, to reduce HCU.

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA):

Usability and preliminary effectiveness of an app-based physical activity and education program for people with hip or knee osteoarthritis - a pilot randomized controlled trial

Background: Hip and knee osteoarthritis (OA) are highly prevalent worldwide. The guidelines recommend physical activity and education as the core treatments for osteoarthritis. Digital health has the potential to engage people in physical activity and disease management. Therefore, we conducted a pilot trial to assess the usability and preliminary effectiveness of an app-based physical activity and education program (Join2Move) compared to usual care for people with hip and/or knee OA in Germany. Methods: A randomized controlled pilot study was conducted. Individuals with diagnosed or self-reported knee and hip OA were included. Allocation to the intervention or control group was randomized. The intervention group received the Join2Move program. The Join2Move program was previously developed as a website and evaluated in the Netherlands. For the current study, the program was translated and adapted to the German context and adjusted from a website to an app. The control group received usual care. The primary outcomes were usability and preliminary effectiveness (pain and physical functioning). Measurements were taken at baseline and at twelve weeks. The data analysis was performed using SPSS (IBM SPSS Statistics 29.0). Results: Sixty participants, with a mean age of 61.9 (SD ± 7.2) years, were allocated to the intervention (n = 32) or the control group (n = 28) and included in the analysis. The majority of participants had knee OA (68%), and 12% had hip and knee OA. The dropout rate was n = 11 (18%). No adverse events were reported. Usability was rated as acceptable (mean System Usability Scale = 71.3/100) with a wide range (32.5 to 100). Statistically significant between-group differences were found only for pain (mean difference 8.52 (95% CI 1.01 to 16.04), p = 0.027). Conclusions: Join2Move demonstrated acceptable usability. The preliminary results of the pilot trial indicate the potential of a stand-alone app for the treatment of patients with hip or knee OA. However, the acceptable usability of Join2Move limits its recommendation for everyone. There appears to be room for improvement in app usability and in identifying patients for whom the app is suitable and the right time to use a stand-alone app.

Prognosis of Pain and Physical Functioning in Patients With Knee Osteoarthritis: A systematic review and meta-analysis

Objective To systematically summarize the literature on the course of pain in patients with knee osteoarthritis (OA), prognostic factors that predict deterioration of pain, the course of physical functioning, and prognostic factors that predict deterioration of physical functioning in persons with knee OA. Methods A search was conducted in PubMed, CINAHL, Embase, Psych‐INFO, and SPORTDiscus up to January 2014. A meta‐analysis and a qualitative data synthesis were performed. Results Of the 58 studies included, 39 were of high quality. High heterogeneity across studies (I2 >90%) and within study populations (reflected by large SDs of change scores) was found. Therefore, the course of pain and physical functioning was interpreted to be indistinct. We found strong evidence for a number of prognostic factors predicting deterioration in pain (e.g., higher knee pain at baseline, bilateral knee symptoms, and depressive symptoms). We also found strong evidence for a number of prognostic factors predicting deterioration in physical functioning (e.g., worsening in radiographic OA, worsening of knee pain, lower knee extension muscle strength, lower walking speed, and higher comorbidity count). Conclusion Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. These findings support current research efforts to define subgroups or phenotypes within knee OA populations. Strong evidence was found for knee characteristics, clinical factors, and psychosocial factors as prognostics of deterioration of pain and physical functioning.