Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care

Dziedzic, Krysia; Allen, Kelli D.

doi:10.1093/rheumatology/key062

Cited by 36 publications

(39 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To facilitate the translation of evidence-based HOA recommendations into practice, several models have been developed for the delivery of HOA care 37. One model is a clinical algorithm that provide a stepwise approach for delivering non-pharmacological and pharmacological therapies 38.…”

Section: Discussionmentioning

confidence: 99%

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial

et al. 2019

View full text Add to dashboard Cite

ObjectivesTo evaluate whether occupational therapy, provided in the period between referral and surgical consultation, might delay or reduce the need of surgery in thumb carpometacarpal joint (CMCJ) osteoarthritis and to explore predictors for CMCJ surgery.MethodsThis multicentre randomised controlled trial included patients referred for surgical consultation due to CMCJ osteoarthritis. An occupational therapy group received hand osteoarthritis education, assistive devices, CMCJ orthoses and exercises. A control group received only hand osteoarthritis information. Primary outcome was the proportion of patients that had received CMCJ surgery after 2 years. We examined the primary outcome and predictors for surgery with regression models, and time to surgery with the log-rank test and cox regression analyses.ResultsOf 221 patients screened for eligibility, 180 were randomised. Information on the primary outcome was collected from medical records for all included patients. Surgery was performed on 22 patients (24%) that had received occupational therapy and 29 (32%) control patients (OR 0.56, 95% CI 0.26 to 1.21; p=0.14). Median time to surgery was 350 days (IQR 210–540) in the occupational therapy group and 296 days (IQR 188–428) in the control group (p=0.13). Previous non-pharmacological treatment (OR 2.72, 95% CI 1.14 to 6.50) and higher motivation for surgery (OR 1.25, 95% CI 1.09 to 1.43) were significant predictors for CMCJ surgery.ConclusionsOccupational therapy showed a small non-significant tendency to delay and reduce the need for surgery in CMCJ osteoarthritis. Previous non-pharmacological treatment and higher motivation for surgery were significant predictors for surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Pragmatic studies that compare the routine integration of DAs into primary versus specialty care could further clarify which groups of patients are most likely to find DAs helpful in treatment decision-making processes, and whether important differences exist across other patientcentered outcomes such as decision certainty and regret. Identifying mechanisms by which DAs can be complemented by such activities as health coaching, shared medical appointments and care management 50,51 to reduce decisional uncertainty could advance the optimal alignment of treatment preferences and decisions for all patients.…”

Section: Resultsmentioning

confidence: 99%

<p>Decision Aid Implementation and Patients’ Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative</p>

Hurley¹,

Wang²,

Rodríguez³

et al. 2020

PPA

View full text Add to dashboard Cite

Background: Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters. Objective: In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients' treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations. Design: Retrospective cohort study. Setting: 10 High Value Healthcare Collaborative (HVHC) health systems. Study participants: A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015. Results: Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations. Conclusion: Patients' treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.

show abstract

“…The surveyed GPs, rheumatologists and orthopaedic surgeons reported that they most used X-ray and MRI in addition to their clinical assessment. Guideline recommendations suggest that a careful clinical examination is su cient, unless there is any additional bene t to imaging patients as part of the diagnostic pathway or to con rm a differential diagnosis (11,25,26). The fact that orthopaedic surgeons showed a substantially higher use of MRI could be due to referrals from other specialists, thus of possibly more severe cases with knee OA to evaluate the surgical option.…”

Section: Discussionmentioning

confidence: 99%

Conservative non-pharmacological management of knee osteoarthritis in Switzerland: a survey among medical specialists

Ettlin¹,

Nast²,

Huber³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: International Guidelines recommend self-management, exercise and weight management if appropriate as first line conservative treatment for patients with knee osteoarthritis (OA). The objective of this study was to survey the conservative non-pharmacological management of patients with knee OA in Switzerland and to explore perceived barriers and facilitators for the application of guideline recommendations. Methods: Based on the results of semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons, a survey was performed across their scientific societies. Questions addressed diagnostic measures, treatment options, reasons for referral to exercise as well as barriers and facilitators. Results: In total, 234 members responded. They indicated that usually patients presented due to pain (n=222, 98.2%) and functional limitations of the knee (n=151, 66.8%). Additionally to clinical assessment X-ray (n=214, 95.5%) and MRI (n=70, 31.3%) were used as diagnostic measures. The referral to exercise, was driven by the patients’ expectation/high level of suffering (n=73, 37.1%), as well as by their own clinical experience (n=49, 24.9%). They estimated to refer 54% of their patients to exercise. Further, the specialists rated as the most important barriers for the referral to exercise ‘disinterest of patient’ (n=88, 46.3%) and ‘physically active patient’ (n=59, 31.1%). As most important facilitators, they rated ‘priority to mention exercise during short time of consultation’ (n=170, 89.4%) and ‘insufficiently physically active patient’ (n=165, 86.9%). Conclusion: A substantial evidence-performance gap in the management of patients with knee OA seems to be present. To successfully support systematic referral to exercise as first line intervention, it may be important to not simply suggest exercise in general, but a specific best-practice exercise and education programme for knee OA.

show abstract

Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care

Cited by 36 publications

References 70 publications

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial

<p>Decision Aid Implementation and Patients’ Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative</p>

Conservative non-pharmacological management of knee osteoarthritis in Switzerland: a survey among medical specialists

Contact Info

Product

Resources

About