The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden

Abstract

We evaluated a structured education- and exercise-based self-management program for patients with knee or hip osteoarthritis (OA), using a registry-based study of data from 44,634 patients taken from the Swedish “Better Management of Patients with Osteoarthritis” registry. Outcome measures included a numeric rating scale (NRS), EuroQol five dimension scale (EQ-5D), Arthritis self-efficacy scale (ASES-pain and ASES-other symptoms), pain frequency, any use of OA medication, desire for surgery, fear–avoidance behavior, physical activity, and sick leave were reported at baseline, 3 and 12 month. Changes in scale variables were analyzed using general linear models for repeated measures and changes in binary variables by McNamara’s test. All analyses were stratified by joint. At the 3-month follow-up, patients with knee (n = 30686) and hip (n = 13948) OA reported significant improvements in the NRS-pain, the EQ-5D index, the ASES-other symptoms, and ASES-pain scores with standardized effect size (ES) ranges for patients with knee OA of 0.25–0.57 and hip OA of 0.15–0.39. Significantly fewer patients reported pain more than once weekly, took OA medication, desired surgery, showed fear–avoidance behavior, and were physically inactive. At the 12-month follow-up, patients with knee (n = 21647) and hip (n = 8898) OA reported significant improvements in NRS-pain, EQ-5D index, and a decrease in ASES-other symptoms and ASES-pain scores with an ES for patients with knee OA of –0.04 to 0.43 and hip OA of –0.18 to 0.22. Significantly fewer patients reported daily pain, desired surgery (for hip OA), reported fear–avoidance behavior, and reported sick leave. Following these interventions, patients with knee and hip OA experienced significant reductions in symptoms and decreased willingness to undergo surgery, while using less OA medication and taking less sick leave. The results indicate that offering this program as the first-line treatment for OA patients may reduce the burden of this disease.

The Active with OsteoArthritis (AktivA) Physiotherapy Implementation Model: A Patient Education, Supervised Exercise and Self-Management Program for Patients with Mild to Moderate Osteoarthritis of the Knee or Hip Joint. A National Register Study with a Two-Year Follow-Up

“…From baseline to the two-year follow-up, the NRS pain scores reduced from 5.2 to 4.1, which is defined as a minimal clinical important change [ 35 ], with an ES of 0.39 ( Table 3 and Figure 1 ). These findings are in correspondence with the results both from the BOA [ 36 ], and GLA;D [ 17 ] registers, showing improvements of almost the same amount. The additional message from the present study is that the reduction in pain is maintained beyond the one-year period documented by the other registers.…”

Musculoskeletal health in the workplace

“…Selfmanagement strategies for people with long-term conditions include patient education and behaviour modification which are designed to build people's feelings of self-efficacy and ability to set goals and take an active role in their own health outcomes and empowering them to have responsibility over the decisions and actions being made about their condition [112]. A Swedish study looking at data from over 44,000 patients with hip or knee osteoarthritis found that a structured education and exercise selfmanagement programme had a significant beneficial effect on quality of life, physical activity, pain, use of medication and sick leave [113]. While this evidence highlights the potential benefits from selfmanagement, there is a lack of research on self-management in the workplace.…”

Patterns of physical activity, adherence to a wearable activity tracker during a 12-week intervention and correlation between physical activity and function in individuals with hip and/or knee osteoarthritis

“…Participants in this study took part of the Supported Osteoarthritis Self-management Program (SOASP). The SOASP is recommended in clinical guidelines for the management of patients with OA in the hip, knee and hand in Sweden (35,36). The SOASP offers rst line treatment for patients with hip, knee and/or hand OA and is generally offered in primary health care.…”