Improving osteoarthritis care by digital means - Effects of a digital self-management program after 24- or 48-weeks of treatment

Dahlberg, Leif; Dell’Isola, Andrea; Lohmander, L. Stefan; Nero, Håkan

doi:10.1371/journal.pone.0229783

Cited by 63 publications

(82 citation statements)

References 33 publications

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“…Patients self-select to receive care in either the traditional model or the digital model of care. Data suggest that there are no significant differences in age or sex between the two models of care; mean age is around 65 years of age and around 75 percent are women in both models [13,14]. In presenting the results of the study, the CHEERS recommendations for reporting the results of an economic evaluation have been followed [15].…”

Section: Methodsmentioning

confidence: 99%

“…The costing analysis compares the resources needed to deliver care with a digital OA treatment program, the Joint Academy ® platform (JA) ( www.jointacademy.com ) [ 13 ], with the best practice face-to-face treatment, the ‘Better Management of Patients with Osteoarthritis program’, or the BOA model [ 14 ]. Both models provide individually tailored first-line management programs including disease information and exercises for patients that have been diagnosed with knee or hip OA.…”

Section: Methodsmentioning

confidence: 99%

“…The model has shown significant effects on key indicators including mobility, pain, and physical function in recent studies [ 11 – 13 , 22 ]. The digital model is initiated by the patient providing key information about his or her condition into the system platform.…”

Section: Methodsmentioning

confidence: 99%

“…In a recent study of the effect of the digital model of care, Nero and colleagues showed that patients with knee OA receiving care in the digital model report on average a reduction in experienced pain from 5.7 to 3.2 (a reduction by 2.5 points on a 0-10 scale, or a 44 percent reduction) after 12 weeks [13]. Patients with knee OA receiving the care in the BOA model report a reduction from 5.2 to 4.1 (a reduction by 1.1 points on a 0-10 scale, or a reduction of 21 percent) after the same amount of time [14].…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

“…Accordingly, some recently developed digital platforms include managing type II diabetes, hypertension and musculoskeletal disorders [ 9 , 10 ]. One of these platforms was developed to manage patients with OA of the knee or hip [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden

et al. 2020

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Osteoarthritis (OA) constitutes a major and increasing burden on patients, health care systems and the broader society. It is estimated that around a quarter of the adult population is affected by OA in the knee and hip and that the prevalence of OA will increase over the coming decades largely due to aging and adverse lifestyle factors. Prevention and effective care are critical to manage the challenges posed by OA. Digital technologies offer opportunities to deliver cost-effective care for chronic diseases, including for OA. We report the results of a costing analysis of a new digital platform for delivering first-line care including disease information and physiotherapy to patients with OA and compare this with an existing face-to-face model of treatment. Both models are in accordance with National Treatment Guidelines in Sweden. The results show that overall the digital model costs around 25% of the existing face-to-face model of care. Based on existing evidence on the effects of these models, our findings also suggest that the digital platform offers a cost-effective alternative to the existing model of OA care. Depending on the extent to which the digital model substitutes for the existing model of care, significant resources can be saved.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Cost-effectiveness Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden

et al. 2020

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Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis

et al. 2021

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IMPORTANCE Osteoarthritis is a prevalent, debilitating, and costly chronic disease for which recommended first-line treatment is underused.OBJECTIVE To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management (ie, usual care). DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted from October 2018 to March 2020. Participants included individuals aged 45 years or older with a diagnosis of knee osteoarthritis recruited from an existing primary care database or from social media advertisements were invited. Data were analyzed April to July 2020. INTERVENTIONSThe intervention and control group conformed to first-line knee osteoarthritis treatment. For the intervention group, treatment was delivered via a smartphone application. The control group received routine self-management care. MAIN OUTCOMES AND MEASURESThe primary outcome was change from baseline to 6 weeks in self-reported pain during the last 7 days, reported on a numerical rating scale (NRS; range, 0-10, with 0 indicating no pain and 10, worst pain imaginable), compared between groups. Secondary outcomes included 2 physical functioning scores, hamstring and quadriceps muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quantitative sensory testing. RESULTS Among a total of 551 participants screened for eligibility, 146 were randomized and 105 were analyzed (mean [SD] age, 66.7 [9.2] years, 71 [67.1%] women), including 48 participants in the intervention group and 57 participants in the control group. There were no significant differences in baseline characteristics between the groups. At the 6-week follow-up, the intervention group showed a greater NRS pain score reduction than the control group (between-group difference, −1.5 [95% CI, −2.2 to −0.8]; P < .001). Similarly, the intervention group had better improvements in the 30-second sit-to-stand test (between-group difference, 3.4 [95% CI, 2.2 to 4.5]; P < .001) and Timed Up-and-Go test (between-group difference, −1.8 [95% CI, −3.0 to −0.5] seconds; P = .007), as well as the WOMAC subscales for pain (between-group difference, −1.1 [95% CI, −2.0 to −0.2]; P = .02), stiffness (between-group difference, −1.0 [95% CI, −1.5 to −0.5]; P < .001), and physical function (between-group difference, −3.4 [95% CI, −6.2 to −0.7]; P = .02). The magnitude of within-group changes in pain (d = 0.83) and function outcomes (30 second sit-to-stand test d = 1.24; Timed Up-and-Go test d = 0.76) in the intervention group corresponded to medium to very strong effects.No adverse events were reported. CONCLUSIONS AND RELEVANCEThese findings suggest that this internet-delivered, evidencebased, first-line osteoarthritis treatment was superior to routine self-managed usual care and could (continued) Key Points Question What is the effectiveness of an internet-based exercise program vs routine self-management on pain outcomes among patients with knee osteoarthritis? Findings This randomized clinical trial including 105 patie...

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Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis

et al. 2022

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ImportanceDigital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.ObjectiveTo compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention.Design, Setting, and ParticipantsThis registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021.ExposuresParticipants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application.Main Outcomes and MeasuresDifference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior.ResultsA total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, −1.10 [95% CI −1.17 to −1.02] points) and digital interventions (mean change, −1.87 [95% CI, −1.94 to −1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, −0.93 [95% CI, −1.04 to −0.81] points). Results of secondary outcomes were broadly consistent with main outcome.Conclusions and RelevanceThis Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.

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Improving osteoarthritis care by digital means - Effects of a digital self-management program after 24- or 48-weeks of treatment

Cited by 63 publications

References 33 publications

Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden

Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden

Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis

Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis

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