Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial

Abstract

Background: To address the well-documented gap between hip and knee osteoarthritis (OA) treatment recommendations and current clinical practice, a structured model for integrated OA care was developed and evaluated in a stepped-wedge cluster-randomised controlled trial. The current study used secondary outcomes to evaluate clinically important response to treatment through the Outcome Measures in Rheumatology Clinical Trials clinical responder criteria (OMERACT-OARSI responder criteria) after 3 and 6 months between patients receiving the structured OA care model vs. usual care. Secondly, the study aimed to investigate if the proportion of responders in the intervention group was influenced by adherence to the exercise program inherent in the model. Methods: The study was conducted in primary healthcare in six Norwegian municipalities. General practitioners and physiotherapists received training in OA treatment recommendations and use of the structured model. The intervention group attended a physiotherapist-led OA education program and performed individually tailored exercises for 8-12 weeks. The control group received usual care. Patient-reported pain, function and global assessment of disease activity during the last week were evaluated using 11-point numeric rating scales (NRS 0-10). These scores were used to calculate the proportion of OMERACT-OARSI responders. Two-level mixed logistic regression models were fitted to investigate differences in responders between the intervention and control group.

Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial

“…This lack of further improvement may relate to inadequate exercise progression, including suboptimal intensities, during this unsupervised phase. Although it is presumed that there is a relationship between exercise adherence and outcomes in knee OA, surprisingly, the nature of the relationship is unclear given the limited research and contradictory findings [ 6 , 48 - 50 ]. For example, some studies using self-report adherence measures have found that greater adherence is linked with better pain and function outcomes [ 6 , 48 , 50 ].…”

“…Although it is presumed that there is a relationship between exercise adherence and outcomes in knee OA, surprisingly, the nature of the relationship is unclear given the limited research and contradictory findings [ 6 , 48 - 50 ]. For example, some studies using self-report adherence measures have found that greater adherence is linked with better pain and function outcomes [ 6 , 48 , 50 ]. In contrast, a study using concealed accelerometers to accurately assess adherence to a 12-week home strengthening program showed no evidence of an association [ 49 ].…”

Physical therapy as a promising treatment for osteoarthritis: A narrative review

“…As mentioned above, there is strong evidence that physical therapy represented by regular exercise can be beneficial for OA. However, inconsistent results are usually obtained by different exercise models and different research groups, mainly because of that most patients cannot strictly follow the requirements of physical therapies (Moseng et al, 2020). The low exercise adherence rate is one of the reasons why exercise therapy does not respond well in some cases (Østerås et al, 2019).…”

Effect of a mHealth exercise intervention compared with supervised exercise therapy in osteoarthritis management: protocol of the DigiOA trial

“…The of OMERACT-OARSI responders in previous research of OA management varies widely. The proportion of responders varies from 25% to 83%, [36][37][38] hence, a conservative estimate in our trial would be 50% being classified as responders. No direct comparison of our study to other trials is to our knowledge available, increasing difficulty of specifying a non-inferior margin.…”