Patients' preferences for osteoarthritis treatment: the value of stated-preference studies

A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint

Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.

Exploring patient treatment decision making for osteoarthritis in the UAE: a cross-sectional adaptive choice-based conjoint study

OBJECTIVE

To assess osteoarthritis (OA) patients' preferences for pharmaceutical treatment via Adaptive Choice-Based Conjoint (ACBC) method.

METHODS

A United Arab Emirates (UAE) based Patient and Public Involvement (PPI) group designed the ACBC questionnaire with 10 attributes and 34 levels. The questionnaire was developed using Sawtooth Software and analyzed through Hierarchical Bayesian (HB). Results were standardized using Z-score via SPSS.

RESULTS

Study participants were 1030 OA patients, 83.6% aged 50 or older and 83.4% female. The avoidance of medication's side effects accounted for 66% relative importance compared to 6% relative importance for the medication's benefits. The "way of taking the medicine" attribute had the highest coefficient of variation (70%) and the four side effect attributes "risk of gastric ulcer, addiction, kidney and liver impairment, and heart attacks and strokes" had a coefficient of variation from 18 to 21%.

CONCLUSIONS

Arab OA patients are similar to other ethnic groups in trading-off benefits and side effects and consistently prioritizing the avoidance of medications' side effects. Although the "Way of taking medicine" was the least important attribute it was associated with the highest variation amongst patients. OA patients also prefer prescribed medications to internet-purchased and over-the-counter options.

The Role of Web-Based Adaptive Choice-Based Conjoint Analysis Technology in Eliciting Patients' Preferences for Osteoarthritis Treatment

OBJECTIVE

To assess the feasibility of using adaptive choice-based conjoint (ACBC) analysis to elicit patients' preferences for pharmacological treatment of osteoarthritis (OA), patients' satisfaction with completing the ACBC questionnaire, and factors associated with questionnaire completion time.

METHODS

Adult patients aged 18 years and older with a medical diagnosis of OA, experiencing joint pain in the past 12 months, and living in the Northeast of England participated in the study. The participants completed a web-based ACBC questionnaire about their preferences regarding pharmaceutical treatment for OA using a touchscreen laptop independently, and accordingly, the questionnaire completion time was measured. Moreover, the participants completed a pen-and-paper feedback form about their experience in completing the ACBC questionnaire.

RESULTS

Twenty participants aged 40 years and older, 65% females, 75% had knee OA, and suffering from OA for more than 5 years participated in the study. About 60% of participants reported completing a computerized questionnaire in the past. About 85% of participants believed that the ACBC task helped them in making decisions regarding their OA medications, and 95% agreed or strongly agreed that they would be happy to complete a similar ACBC questionnaire in the future. The average questionnaire completion time was 16 min (range 10-24 min). The main factors associated with longer questionnaire completion time were older age, never using a computer in the past, and no previous experience in completing a questionnaire.

CONCLUSIONS

The ACBC analysis is a feasible and efficient method to elicit patients' preferences for pharmacological treatment of OA, which could be used in clinical settings to facilitate shared decision-making and patient-centered care. The ACBC questionnaire completion consumes a significantly longer time for elderly participants, who never used a computer, and never completed any questionnaire previously. Therefore, the contribution of patients and public involvement (PPI) group in the development of the ACBC questionnaire could facilitate participants' understanding and satisfaction with the task. Future research including patients with different chronic conditions may provide more useful information about the efficiency of ACBC analysis in eliciting patients' preferences for osteoarthritis treatment.

Exploring perceptions of using preference elicitation methods to inform clinical trial design in rheumatology: A qualitative study and OMERACT collaboration

BACKGROUND

Clinical trial design requires value judgements and understanding patient preferences may help inform these judgements, for example when prioritizing treatment candidates, designing complex interventions, selecting appropriate outcomes, determining clinically important thresholds, or weighting composite outcomes. Preference elicitation methods are quantitative approaches that can estimate patients' preferences to quantify the absolute or relative importance of outcomes or other attributes relevant to the decision context. We aimed to explore stakeholder perceptions of using preference elicitation methods to inform judgements when designing clinical trials in rheumatology.

METHODS

We conducted 1-on-1 semi-structured interviews with patients with rheumatic diseases and rheumatology clinicians/researchers, recruited using purposive and snowball sampling. Participants were provided pre-interview materials, including a video and a document, to introduce the topic of preference elicitation methods and case examples of potential applications to clinical trials. Interviews were conducted via Zoom and were audio-recorded and transcribed. We used thematic analysis to analyze our data.

RESULTS

We interviewed 17 patients and 9 clinicians/researchers, until data and inductive thematic saturation were achieved within each group. Themes were grouped into overall perceptions, barriers, and facilitators. Patients and clinicians/researchers generally agreed that preference elicitation studies can improve clinical trial design, but that many considerations are required around preference heterogeneity and feasibility. A key barrier identified was the additional resources and expertise required to measure and incorporate preferences effectively in trial design. Key facilitators included developing guidance on how to use preference elicitation to inform trial design, as well as the role of external decision-makers in developing such guidance, and the need to leverage the movement towards patient engagement in research to encourage including patient preferences when designing trials.

CONCLUSION

Our findings allowed us to consider the potential applications of patient preferences in trial design according to stakeholders within rheumatology who are involved in the trial process. Future research should be conducted to develop comprehensive guidance on how to meaningfully include patient preferences when designing clinical trials in rheumatology. Doing so may have important downstream effects for shared decision-making, especially given the chronic nature of rheumatic diseases.

Possible synergic action of non-steroidal anti-inflammatory drugs and glucosamine sulfate for the treatment of knee osteoarthritis: a scoping review

BACKGROUND

Several studies have reported that glucosamine sulfate (GS) can improve knee osteoarthritis (OA) symptomatology. In parallel, the disease-modifying effects of non-steroidal anti-inflammatory drugs (NSAIDs) in knee OA have also been investigated. However, limited literature has reported the combined effect of GS and NSAIDs. The aim of this scoping review is to describe the scope and volume of the literature investigating the potential benefits and synergistic effect of a combination of GS and NSAIDs in patients with knee OA.

METHODS

PubMed and Embase were searched for studies published from inception through April 2022, evaluating the effects of the combination of GS and NSAIDs in OA patients, versus either treatment alone. Data are reported narratively.

RESULTS

Five studies were included in this review; 4 were randomized control trials and one was a prospective observational study. The duration of combination treatment was 6 to 12 weeks. The combination was compared to celecoxib in 2 studies, meloxicam in 1, etoricoxib in 1, and a conventional NSAID in 1 (ibuprofen or piroxicam). All 5 studies reported that in patients with knee OA, the combination of GS plus NSAID yielded a significantly greater benefit than single-agent therapy, in terms of outcomes including pain reduction, function, joint stiffness, and markers of inflammatory activity and cartilage degradation.

CONCLUSION

The 5 studies included in this scoping review all report a significantly greater clinical benefit with a combination of GS plus NSAID compared to either treatment alone. The evidence supports efficacy in reducing pain, improving function, and possibly regulating joint damage. However, further randomized trials with larger sample sizes are warranted to confirm these findings.

Identification of Relevant Attributes for Liver Cancer Therapies (IRALCT): a maximum-difference-scaling analysis

The Identification of Relevant Attributes for Liver Cancer Therapies (IRALCT) project is intended to provide new insights into the relevant utility attributes regarding therapy choices for malignant primary and secondary liver tumors from the perspective of those who are involved in the decision-making process. It addresses the potential value of taking patients' expectations and preferences into account during the decision-making and, when possible, adapting therapies according to these preferences. Specifically, it is intended to identify the relevant clinical attributes that influence the patients', medical laymen's, and medical professionals' decisions and compare the three groups' preferences. We conducted maximum difference (MaxDiff) scaling among 261 participants (75 physicians, 97 patients with hepatic malignancies, and 89 medical laymen) to rank the importance of 14 attributes previously identified through a literature review. We evaluated the MaxDiff data using count analysis and hierarchical Bayes estimation (HB). Physicians, patients, and medical laymen assessed the same 7 attributes as the most important: probability (certainty) of a complete removal of the tumor, probability of reoccurrence of the disease, pathological evidence of tumor removal, possible complications during the medical intervention, welfare after the medical intervention, duration and intensity of the pain, and degree of difficulty of the medical intervention. The cumulative relative importance of these 7 attributes was 88.3%. Our results show that the physicians', patients', and medical laymen's preferences were very similar and stable.Trial registration DRKS-ID of the study: DRKS00013304, Date of Registration in DRKS: 2017/11/16.

Conjoint Analysis: A Research Method to Study Patients’ Preferences and Personalize Care

This article aims to describe the conjoint analysis (CA) method and its application in healthcare settings, and to provide researchers with a brief guide to conduct a conjoint study. CA is a method for eliciting patients’ preferences that offers choices similar to those in the real world and allows researchers to quantify these preferences. To identify literature related to conjoint analysis, a comprehensive search of PubMed (MEDLINE), EMBASE, Web of Science, and Google Scholar was conducted without language or date restrictions. To identify the trend of publications and citations in conjoint analysis, an online search of all databases indexed in the Web of Science Core Collection was conducted on the 8th of December 2021 without time restriction. Searching key terms covered a wide range of synonyms related to conjoint analysis. The search field was limited to the title, and no language or date limitations were applied. The number of published documents related to CA was nearly 900 during the year 2021 and the total number of citations for CA documents was approximately 20,000 citations, which certainly shows that the popularity of CA is increasing, especially in the healthcare sciences services discipline, which is in the top five fields publishing CA documents. However, there are some limitations regarding the appropriate sample size, quality assessment tool, and external validity of CA.

Patients' preferences for quality-of-life aspects in sarcopenia: a best-worst scaling study

PURPOSE

As information on patients' preferences regarding quality-of-life aspects in sarcopenia is lacking, this study aims to assess the relative importance of the 14 items of a QoL questionnaire designed for sarcopenia (the SF-SarQoL) using a best-worst scaling (BWS) survey.

METHODS

Participants, aged 65 years or older and community dwelling, who previously participated in the SarcoPhAge study, received a BWS survey via the mail. An object case BWS was selected in which participants completed 12 choice tasks, picking the most and least important aspect from 4 out of 14 SF-SarQoL items for each task. Relative importance scores (RIS) were estimated using Hierarchical Bayes modelling. A cluster analysis was also conducted to investigate whether several profiles with regards to QoL preferences were present.

RESULTS

A total of 163 participants were included, aged 75 (IQR: 73-81) years old, and mostly women (n = 107; 65.6%). Two items were found to be significantly more important than others: "feeling a reduction of physical capacity" (RIS = 11.26), and "having balance problems" (RIS = 11.09). The least important items were "experiencing difficulty carrying heavy objects" (RIS = 2.89), and "feeling a reduction in muscle mass" (RIS = 3.82). We found relatively weak evidence for the presence of two clusters. One cluster prioritized items related to falls where the second prioritized items related to feeling physically capable.

CONCLUSION

Not all QoL aspects were equally important. The relative weight of each QoL aspect may be used to interpret QoL results obtained with the SF-SarQoL or to inform target outcomes in interventional studies.

Patient preferences to value health outcomes in rheumatology clinical trials: Report from the OMERACT special interest group✰

OBJECTIVE

To inform a research plan for future studies by obtaining stakeholder input on the application of preference-based methods to clinical trial design.

METHODS

We conducted a virtual OMERACT session to encourage stakeholder engagement. We developed materials for the session to facilitate discussion based on identified case examples and feedback sessions.

RESULTS

Participants prioritized incorporating patient preferences in all aspects of trial design with an emphasis on outcome selection. Participants highlighted the need for careful consideration around preference heterogeneity and equity factors.

CONCLUSION

Including patient preferences in trial design was considered a priority requiring further exploration to develop comprehensive guidance.

Patient and physician perspectives guiding intra-articular treatment choice in knee osteoarthritis: stakeholders are aligned on treatment priorities but have different assessments of treatment effect

OBJECTIVES

Knee osteoarthritis (OA) is a leading cause of health-related disability. In the absence of curative non-operative therapies, treatment goals are limited to symptom relief. Data are limited on how patients and physicians prioritise available treatment options. We assessed patients' preferences for and physicians' attitudes towards intra-articular treatments including corticosteroids (IACS), an extended-release corticosteroid (TA-ER) and hyaluronic acids (IAHA).

METHODS

We conducted a prospective, IRB-exempt, double-blind survey of patients with and providers who treat knee OA. Respondents were required to have received or prescribed TA-ER in a non-trial setting. We evaluated patients' OA history, impact of knee OA and treatment preferences, and physicians' decision-making and prescribing experiences.

RESULTS

Of the 97 patient participants, mean age was 56 years, 70.0% were women, 75.0% had bilateral knee OA and 46.4% were diagnosed over 5 years ago. Of the 50 physician participants, 42.0% were orthopaedic surgeons, 34.0% were rheumatologists and 60.0%, on average, treat 50+ patients with knee OA per month. Treatment selection factors considered 'very important' to patients and physicians included disease severity (88.7%, 82.0%), impact on quality of life (88.7%, 72.0%), disease extent (84.5%, 54.0%) and activity level (80.4%, 64.0%). A majority (93.8%) of patients indicated moderate to severe difficulty with their knees. Fewer patients (76.3%) reported shared decision making compared with physicians (92.0%). Half (50.5%) of the patients reported that they experienced months of pain relief with TA-ER, 27.7% with IACS and 18.8% with IAHA. Physician assessments were consistent but estimated a greater duration of treatment effects than that reported by patients across all therapies.

CONCLUSION

While knee OA has a tremendous impact on patients, there are significant unmet treatment needs. The increasing use of patient-reported outcomes will allow patients and physicians to track pain and functional status over time and across therapies, improving shared decision-making.

Impact of sarcopenia on rehabilitation outcomes after total knee replacement in older adults with knee osteoarthritis

Introduction:

Knee osteoarthritis (KOA) is associated with an increased risk of sarcopenia, and aging-related muscle deterioration continues after total knee replacement (TKR). Low skeletal muscle mass index may influence postoperative rehabilitation outcomes. Through this study, we aimed to investigate the impact of preoperative sarcopenia on clinical outcomes after postoperative rehabilitation in older Asian adults.

Methods:

A total of 190 older adults (39 men, 151 women) were enrolled from two previous trials and were classified as having no sarcopenia, class I sarcopenia, or class II sarcopenia according to definitions provided by the Asian Working Group for Sarcopenia (AWGS) and the European Working Group on Sarcopenia in Older People (EWGSOP). All patients were retrospectively analyzed before (T₀) and after (T₁) TKR rehabilitation and 10 months after surgery (T₂). The outcome measures included the timed up-and-go test (TUGT), gait speed (GS), timed chair rise (TCR), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical difficulty (WOMAC-PF). With patient characteristics and T₀ scores as covariates, an analysis of variance was performed to identify intergroup differences in changes of all outcome measures at T₁ and T₂.

Results:

According to the definitions of both the AWGS and EWGSOP, patients with class I and class II sarcopenia exhibited minor changes in TUGT, GS, TCR, and WOMAC-PF at T₁ and T₂ (all p < 0.05), compared with those without sarcopenia. For patients classified as having sarcopenia based on AWGS and EWGSOP definitions, no significant intergroup differences in WOMAC pain score was observed at T₁ or T₂ (all p > 0.05).

Conclusions:

Sarcopenia independently had negative impacts on the treatment effects of rehabilitation on physical mobility but not on pain outcome after TKR in older adults with KOA.

Systematic Review of Studies Using Conjoint Analysis Techniques to Investigate Patients' Preferences Regarding Osteoarthritis Treatment

BACKGROUND

The use of conjoint analysis (CA) to elicit patients' preferences for osteoarthritis (OA) treatment has the potential to contribute to tailoring treatments and enhancing patients' compliance and adherence. This review's main aim was to identify and summarise the evidence that used conjoint analysis techniques to quantify patient preferences for OA treatments.

METHODS

A comprehensive search strategy was conducted using electronic databases and hand reference checks. Databases were searched from their inception until 10th June 2019. All OA and CA related terms were used to conduct the search. The authors reviewed the papers and used the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) checklist to assess the quality of the included studies.

RESULTS

The search identified 534 records. Sixteen records were selected for full-text review and quality assessment and all were included in the narrative data synthesis. All included studies suggested that the severity of symptoms influenced the patients' preference for OA treatment. All included studies recognised CA as a useful method to investigate patients' preferences concerning OA treatment.

CONCLUSION

Patients preference for OA treatment is driven by the severity of patients' symptoms and the desire to avoid treatment side effects and CA is a useful tool to investigate patients' preferences for OA treatment.

Patients' Preferences Regarding Osteoarthritis Medications: An Adaptive Choice-Based Conjoint Analysis Study

BACKGROUND AND OBJECTIVE

Osteoarthritis (OA) patients consider ranges of harms and benefits offered by alternative pharmaceutical treatments. Choice-based experiments provide a mechanism to value outcomes, but they can pose a significant burden on respondents. Thus, the number of attributes studied is typically artificially restricted. We used an adaptive choice-based conjoint (ACBC) method that allows the inclusion of more attributes affecting patients' preferences regarding non-invasive pharmaceutical treatment for OA than traditional choice-based technique to better understand the trade-offs that OA patients consider, without increasing respondents' burden.

METHODS

After consulting with OA patients and public involvement (PPI) group, we constructed an online ACBC survey consisting of 9 attributes and a total of 31 levels (two benefits, four harms and three concerning the availability and modality of treatment). A cohort of patients with a diagnosis of OA and reporting joint pain within the last 12 months were recruited.

RESULTS

Our study (n 43) showed that the most important factor in choosing OA medication was the risk of heart attacks and strokes (19.5%), followed by the risk of addiction (18.4%), risk of kidney and liver side effects (17.5%), risk stomach side effects (14.6%), availability (11.6%), frequency of use (5.3%), pain reduction (5%), way of taking medication (4.6%) and mobility improvement (3.5%).

CONCLUSION

ACBC provides a mechanism for understanding patient preferences that address the limitations of traditional choice-based experiments. For OA patients, avoidance of the risk of side effects were the most affecting medication choices, and reductions in pain and mobility were the least. Clinicians discussing options for medication with OA patients should discuss the potential trade-offs in terms of risks and benefits.

Patient perspectives surrounding intra-articular injections for knee osteoarthritis: A qualitative study

OBJECTIVE

Intra-articular (IA) injections are used frequently for knee osteoarthritis (OA), but little is known about patients' attitudes towards these therapies. We aimed to better understand patients' perceptions of the facilitators of and barriers to IA injections for knee OA.

METHODS

We conducted a qualitative, descriptive/exploratory study and held focus groups and individual interviews with participants with knee OA, including some who had received IA injections and others who had not received IA injections. We conducted a thematic analysis to identify themes describing the factors participants found influential when deciding whether to try an IA injection.

RESULTS

We held three focus groups with 12 participants and conducted three individual interviews (15 participants total). We identified four themes that shaped participants' decisions to receive a specific injection: 1) the impact of OA on participants' lives; 2) participants' attitudes and concerns, including desire to avoid surgery, willingness to accept uncertain outcomes, and concerns about side effects and dependence; 3) the way participants gathered and processed information from physicians, peers, and the internet; and 4) availability of injectable products. Participants weighed the desire to regain function and delay surgery with concerns about side effects, uncertain efficacy, and costs.

CONCLUSION

Participants were concerned about the effectiveness, toxicity, availability, and cost of injectable products. They balanced disparate sources of information, uncertain outcomes, limited product availability, and other injection-related concerns with a desire to decrease pain. These findings can provide clinicians, investigators, and public health professionals with insights into challenges patients face when making injection decisions.

A discrete-choice experiment to assess patients' preferences for osteoarthritis treatment: An ESCEO working group

OBJECTIVE

To evaluate the preferences of patients with osteoarthritis for treatment.

METHODS

A discrete-choice experiment was conducted among adult OA patients who were presented with 12 choice sets of two treatment options and asked in each to select the treatment they would prefer. Based on literature reviews, expert consultation, patient survey and expert meeting, treatment options were characterized by seven attributes: improvement in pain, improvement in walking, ability to manage domestic activities, ability to manage social activities, improvement in overall energy and well-being, risk of moderate/severe side effects and impact on disease progression. Random parameters logit model was used to estimate patients' preferences and a latent class model was conducted to explore preferences classes.

RESULTS

253 OA patients from seven European countries were included (74% women; mean age 71.3 years). For all seven treatment attributes, significant differences were observed between levels. Given the range of levels of each attribute, the most important treatment attribute in this group was impact on disease progression (29.5%) followed by walking improvement (17.1%) and pain improvement (16.3%). The latent class model identified two preference classes. In the first class (probability of 56%), patients valued impact of disease progression the most (39%). In the second class, walking improvement and improvement in overall energy and well-being were the most important (23%).

CONCLUSION

This study suggests that all seven treatment attributes were important for OA patients. Overall, given the range of levels, the most important outcomes were impact on disease progression and improvement in pain and walking.

The significant effect on musculoskeletal metabolism and bone density of the Eastern Mediterranean Christian Orthodox Church fasting

OBJECTIVE

Nutritional disorders cause secondary osteoporosis as well as musculoskeletal metabolism dysfunction. The Christian Orthodox Church's fasting in Mediterranean countries such Greece and Cyprus, or M.C.O.C. diet consists of self-restraint from food and/or food categories for 180 ± 19 days of total, especially of animal protein and dairy products. This case-control study attempts to investigate the effect of this fasting pattern on musculoskeletal metabolism and bone density.

DESIGN

One hundred fasters (or M.C.O.C. diet followers; 68 women and 32 men, mean 59 ± 6.5) with 32 years average fasting time and 100 non-fasters (66 females and 34 males, mean 58.1 ± 6.8; the control group of Mediterranean diet followers) over the age of 50, including menopausal women, were interviewed, as well as physically and laboratory examined along with DEXA measurements of the L2-4 vertebrae and hips. Nutrition data gathered through a 3-day food record during a non-fasting period, while energy intakes calculated on a daily food consumption basis.

RESULTS

Given the overall low incidence of osteoporosis in the Mediterranean diet, it appears to be more than three times higher than that of M.C.O.C. diet despite the periodic restriction of food intake of animal origin into a slightly hypothermic pattern, which in turn is characterized by increased consumption of multicolored vegetable foods.

CONCLUSIONS

Abstinence from dairy products and meat does not adversely affect musculoskeletal metabolism or bone density. M.C.O.C. diet seems to be "healthy" eating habit for the musculoskeletal system, as future studies expected to confirm.

Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions.

INTRODUCTION

Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication.

METHODS

A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken.

RESULTS

Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it.

CONCLUSION

These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.

Impact of osteoarthritis on activities of daily living: does joint site matter?

Background

We consider the relationships between a clinical and radiological diagnosis of knee or hip OA and activities of daily-living (ADL) in older adults.

Methods

Data were available for 222 men and 221 women from the Hertfordshire Cohort Study (HCS) who also participated in the UK component of the European Project on Osteoarthritis (EPOSA). Participants completed the EuroQoL survey where they reported if they had difficulties with mobility, self-care, usual activities and movement around their house. Hip and knee radiographs were graded for overall Kellgren and Lawrence score (positive definition defined as a 2 or above). Clinical OA was defined using American College of Rheumatology criteria.

Results

In men, a clinical diagnosis of hip or knee OA were both associated with reported difficulties in mobility, ability to self-care and performing usual-activities (hip OA: OR 17.6, 95% CI 2.07, 149, p = 0.009; OR 12.5, 95% CI 2.51, 62.3, p = 0.002; OR 4.92, 95% CI 1.06, 22.8, p = 0.042 respectively. Knee OA: OR 8.18, 95% CI 3.32, 20.2, p < 0.001; OR 4.29, 95% CI 1.34, 13.7, p = 0.014; OR 5.32, 95% CI 2.26, 12.5, p < 0.001 respectively). Similar relationships were seen in women, where in addition, a radiological diagnosis of knee OA was associated with difficulties performing usual activities (OR 3.25, 95% CI 1.61, 6.54, p = 0.001). In general, men with OA reported stronger associations between moving around the house, specifically around the kitchen (clinical hip OA: OR 13.7, 95% CI 2.20, 85.6, p = 0.005; clinical knee OA OR 8.45, 95% CI 1.97, 36.2, p = 0.004) than women.

Discussion and conclusion

Clinical OA is strongly related to the ability to undertake ADL in older adults and should be considered in clinic consultations when seeing patients with OA.