5.
Implementing an early multimodal non-surgical treatment strategy for
knee and hip osteoarthritis in clinical practice – a study of feasibility and
effectiveness
Søren Thorgaard Skou, Anders Odgaard, Jens Ole Rasmussen, Ewa M. Roos
Orthopaedic Surgery Research Unit and Department of Health Science and
Technology Aalborg Hospital - Aarhus University Hospital and Centre for
Sensory-Motor Interaction, Aalborg Univ; Danish Knee Arthroplasty Register
and Division of Knee Surgery, Department of Orthopaedics, Aarhus University
Hospital; GIGT og RYG - Clinic For Physiotherapy, Odense, ; Research Unit
for Musculoskeletal Function and Physiotherapy, Institute of Sports Science
and Clinical Biomechanics, University of Southern Denmark
Background:
In knee and hip OA an early multimodal non-surgical treatment
strategy is recommended in current national and international guidelines.
However clinical practice does not reflect the recommendations.
Purpose / Aim of Study:
The aim of this study was to examine the
effectiveness and feasibility of such a treatment strategy (Good Life with
osteoArthritis in Denmark – GLA:D) in patients with mild to moderate knee
and/or hip OA-related pain.
Materials and Methods:
Thirty-six patients participated in this pilot study.
The treatment strategy consisted of two 1.5 hour sessions of patient education
containing information on OA and treatment of the disease and six weeks of
individualised neuromuscular exercise according to the NEMEX-TJR
program. Primary outcome was pain on a visual analogue scale (0-100) after 3
months. Secondary outcomes were timed 20-meter walk and EQ-5D.
Compliance with exercise was measured as number of exercise sessions
completed out of the expected 12 sessions while compliance with GLA:D in
general was registered using a five-point scale assessing the adherence to the
treatment (never, every month, every week, every day, several times a day).
Paired samples t- test was applied to evaluate the effect of the treatment
strategy.
Findings / Results:
There were a significant (p<0.05) reduction in pain (-16),
in timed 20-meter walk (0.7s.) and a significant increase in EQ-5D (0.053).
Compliance was high in relation to both patient education (89% used what
they had learned every week) and exercise (87% participated in 10-12 of the
sessions).
Conclusions:
The pilot study showed that GLA:D reduced pain and improved
function and quality of life and that it was feasible and possible to implement
into clinical care. Introducing GLA:D nationwide would improve the
adherence to clinical guidelines and the quality of the treatment of knee and
hip OA.
