Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review

Mazzei, Darren; Ademola, Ayoola; Abbott, J. Haxby; Sajobi, Tolulpe; Hildebrand, Kevin A.; Marshall, Deborah

doi:10.1016/j.joca.2020.10.002

Cited by 53 publications

(56 citation statements)

References 56 publications

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“…Exercise has been shown to have a similar analgesic effect but better cost-effectiveness than prescription analgesic medications for pain secondary to knee OA (15,16). The all-cause mortality reducing effects of exercise (17) and the potentially harmful side effects of prolonged analgesic use (18)(19)(20) are further reasons why first-step priority of exercise over pharmacological treatments is recommended in the Swedish guidelines (4) and even international guidelines (21).…”

Section: Discussionmentioning

confidence: 99%

Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

et al. 2021

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“…Osteoarthritis (OA) is a disease of an entire synovial joint characterized by degradation of joint cartilaginous tissues, including articular cartilage and meniscus, and clinical symptoms, such as joint pain and disability [ 1 , 2 ]. Although a number of therapeutic strategies have been developed to alleviate tissue damage in OA, including lifestyle improvement, pharmaceutical management, and arthroscopic debridement, currently, there are few curable treatments available until the end stage of the disease necessitates joint replacement [ 3 , 4 ]. Accumulated studies prove that complex crosstalk of genetic, biochemical, biomechanical, and metabolic factors is involved in OA development [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical-grade human dental pulp stem cells suppressed the activation of osteoarthritic macrophages and attenuated cartilaginous damage in a rabbit osteoarthritis model

Li¹,

Wang²,

Zhao³

et al. 2021

Stem Cell Res Ther

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Background Although increasing evidence has demonstrated that human dental pulp stem cells (hDPSCs) are efficacious for the clinical treatment of skeletal disorders, the underlying mechanisms remain incompletely understood. Osteoarthritis (OA) is one of the most common degenerative disorders in joints and is characterized by gradual and irreversible cartilaginous tissue damage. Notably, immune factors were newly identified to be closely related to OA development. In this study, we explored the modulatory effects of clinical-grade hDPSCs on osteoarthritic macrophages and their protective effects on cartilaginous tissues in OA joints. Methods The cell morphology, immunophenotype, and inflammatory factor expression of osteoarthritic macrophages were explored by phase contrast microscope, transmission electron microscopy, immunostaining, flow cytometry, quantitative polymerase chain reaction, and enzyme linked immunosorbent assay, respectively. Additionally, the factors and signaling pathways that suppressed macrophage activation by hDPSCs were determined by enzyme-linked immunosorbent assay and western-blotting. Furthermore, hDPSCs were administered to a rabbit knee OA model via intra-articular injection. Macrophage activation in vivo and cartilaginous tissue damage were also evaluated by pathological analysis. Results We found that hDPSCs markedly inhibited osteoarthritic macrophage activation in vitro. The cell morphology, immunophenotype, and inflammatory factor expression of osteoarthritic macrophages changed into less inflammatory status in the presence of hDPSCs. Mechanistically, we observed that hDPSC-derived hepatocyte growth factor and transforming growth factor β1 mediated the suppressive effects on osteoarthritic macrophages. Moreover, phosphorylation of MAPK pathway proteins contributed to osteoarthritic macrophage activation, and hDPSCs suppressed their activation by partially inactivating those pathways. Most importantly, injected hDPSCs inhibited macrophage activation in osteochondral tissues in a rabbit knee OA model in vivo. Further histological analysis showed that hDPSCs alleviated cartilaginous damage to knee joints. Conclusions In summary, our findings reveal a novel function for hDPSCs in suppressing osteoarthritic macrophages and suggest that macrophages are efficient cellular targets of hDPSCs for alleviation of cartilaginous damage in OA. Graphical abstract hDPSCs treat OA via an osteoarthritic macrophages-dependent mechanisms. hDPSCs suppress the activation of osteoarthritic macrophages in vitro and in vivo and alleviate cartilaginous lesions in OA models.

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“…Results from previous evaluations of the cost-effectiveness of first-line treatment including exercise therapy and targeting knee or hip OA are heterogeneous, and little is known about the cost-effectiveness of supervised education and exercise therapy implemented in primary care. 14 15 Such evaluation is warranted when deciding whether to implement a structured first-line treatment programme, and therefore the aim of the study was to evaluate the cost-effectiveness of GLA:D. We hypothesised that GLA:D would be cost-effective for both knee and hip OA patients.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of an 8-week supervised education and exercise therapy programme for knee and hip osteoarthritis: a pre–post analysis of 16 255 patients participating in Good Life with osteoArthritis in Denmark (GLA:D)

Grønne

Roos

Ibsen³

et al. 2021

BMJ Open

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ObjectivesTo evaluate 1-year cost-effectiveness of an 8-week supervised education and exercise programme delivered in primary care to patients with symptomatic knee or hip osteoarthritis (OA).DesignA registry-based pre–post study linking patient-level data from the Good Life with osteoArthritis in Denmark (GLA:D) registry to national registries in Denmark.Setting and participants16 255 patients with symptomatic knee or hip OA attending GLA:D.InterventionGLA:D is a structured supervised patient education and exercise programme delivered by certified physiotherapists and implemented in Denmark.Outcome measuresAdjusted healthcare costs per Quality-Adjusted Life Year (QALY) gained from baseline to 1 year (ratio of change in healthcare costs to change in EuroQoL 5-Dimensions 5-Level questionnaire (EQ-5D)). All adjusted measures were estimated using a generalised estimating equation gamma regression model for repeated measures. Missing data on EQ-5D were imputed with Multiple Imputations (3 months: 23%; 1 year: 39 %).ResultsAdjusted change in healthcare cost was 298€ (95% CI: 206 to 419) and 640€ (95% CI: 400 to 1009) and change in EQ-5D was 0.035 (95% CI: 0.033 to 0.037) and 0.028 (95% CI: 0.025 to 0.032) for knee and hip patients, respectively. Hence estimated adjusted healthcare costs per QALY gained was 8497€ (95% CI: 6242 to 11 324) for knee and 22 568€ (95% CI: 16 000 to 31 531) for hip patients. In patients with high compliance, the adjusted healthcare costs per QALY gained was 5438€ (95% CI: 2758 to 9231) for knee and 17 330€ (95% CI: 10 041 to 29 364) for hip patients. Healthcare costs per QALY were below conventional thresholds for willingness-to-pay at 22 804€ (20 000£) and 43 979€ (US$50 000), except the upper limit of the 95% CI for hip patients which was in between the two thresholds.ConclusionsA structured 8-week supervised education and exercise programme delivered in primary care was cost-effective at 1 year in patients with knee or hip OA supporting large-scale implementation in clinical practice.

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Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review

Cited by 53 publications

References 56 publications

Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

Clinical-grade human dental pulp stem cells suppressed the activation of osteoarthritic macrophages and attenuated cartilaginous damage in a rabbit osteoarthritis model

Cost-effectiveness of an 8-week supervised education and exercise therapy programme for knee and hip osteoarthritis: a pre–post analysis of 16 255 patients participating in Good Life with osteoArthritis in Denmark (GLA:D)

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