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
Open Access
- 13 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Musculoskeletal Disorders
- Vol. 21 (1), 1-11
- https://doi.org/10.1186/s12891-020-03235-z
Abstract
BackgroundTo 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 6months 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.MethodsThe 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 8-12weeks. 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.ResultsTwo hundred eighty-four intervention and 109 control group participants with hip and knee OA recruited from primary care in six Norwegian municipalities. In total 47% of the intervention and 35% of the control group participants were responders at 3 or 6months combined; showing an uncertain between-group difference (ORadjusted 1.38 (95% CI 0.41, 4.67). In the intervention group, 184 participants completed the exercise programme (exercised >= 2 times/week for >= 8weeks) and 55% of these were classified as responders. In contrast, 28% of the 86 non-completers were classified as responders.ConclusionsThe difference in proportion of OMERACT-OARSI responders at 3 and 6months between the intervention and control group was uncertain. In the intervention group, a larger proportion of responders were seen among the exercise completers compared to the non-completers.Clinical trial registrationClinicaltrials.gov identifier: NCT02333656. Registered 7. January 2015.Other Versions
Funding Information
- Norges Forskningsråd (229079)
- Norwegian Fund for Post-Graduate Training in Physiotherapy (62458)
This publication has 40 references indexed in Scilit:
- A 12-Week Exercise Therapy Program in Middle-Aged Patients With Degenerative Meniscus Tears: A Case Series With 1-Year Follow-upJournal of Orthopaedic & Sports Physical Therapy, 2012
- “Beating osteoARThritis”: Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritisClinical Rheumatology, 2011
- Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy AdultsMedicine & Science in Sports & Exercise, 2011
- The Problem of Subgroup Analyses: An Example from a Trial on Ruptured Intracranial AneurysmsAmerican Journal of Neuroradiology, 2011
- Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic reviewManual Therapy, 2010
- Development of a Therapeutic Exercise Program for Patients With Osteoarthritis of the HipPTJ: Physical Therapy & Rehabilitation Journal, 2010
- Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trialBMJ, 2006
- A comparison of the OARSI response criteria with patient's global assessment in patients with osteoarthritis of the hip treated with a non-pharmacological interventionOsteoarthritis and Cartilage, 2006
- Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensusRheumatology, 2005
- Development and evaluation of a scale to measure perceived self‐efficacy in people with arthritisArthritis & Rheumatism, 1989