1
|
Selçuk H, Roos EM, Grønne DT, Thorlund JB, Sarı Z, Skou ST. Do self-reported knee instability, difficulty twisting, and knee confidence change after exercise and education in patients with knee osteoarthritis? Musculoskeletal Care 2024; 22:e1884. [PMID: 38635457 DOI: 10.1002/msc.1884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Halit Selçuk
- Department of Physiotherapy and Rehabilitation, Trakya University, Edirne, Turkey
- Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jonas B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Zübeyir Sarı
- Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| |
Collapse
|
2
|
Johansson MS, Pottegård A, Søndergaard J, Englund M, Grønne DT, Skou ST, Roos EM, Thorlund JB. Use of prescribed analgesics before and after exercise therapy and patient education in patients with knee or hip osteoarthritis. Rheumatol Int 2024; 44:319-328. [PMID: 37775621 PMCID: PMC10796603 DOI: 10.1007/s00296-023-05432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Abstract
The aim of this study was to investigate utilisation patterns of prescribed analgesics before, during, and after an exercise therapy and patient education program among patients with knee or hip osteoarthritis. This cohort study is based on data from the nationwide Good Life with osteoarthritis in Denmark (GLA:D®) patient-register linked with national health registries including data on prescribed analgesics. GLA:D® consists of 8-12 weeks of exercise and patient education. We included 35,549 knee/hip osteoarthritis patients starting the intervention between January 2013 and November 2018. Utilisation patterns the year before, 3 months during, and the year after the intervention were investigated using total dispensed defined daily doses (DDDs) per month per 1000 population as outcome. During the year before the intervention, use of prescribed paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids increased with 85%, 79% and 22%, respectively. During the intervention, use of paracetamol decreased with 16% with a stable use the following year. Use of NSAIDs and opioids decreased with 38% and 8%, respectively, throughout the intervention and the year after. Sensitivity analyses indicated that the prescription of most analgesics changed over time. For paracetamol, NSAIDs, and opioids, 10% of analgesic users accounted for 45%, 50%, and 70%, respectively, of the total DDDs dispensed during the study period. In general, analgesic use increased the year before the intervention followed by a decrease during the intervention and the year after. A small proportion of analgesic users accounted for half or more of all paracetamol, NSAIDs, and opioids dispensed during the study period.
Collapse
Affiliation(s)
- Melker S Johansson
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Ackerman IN, Johansson MS, Grønne DT, Clausen S, Ernst MT, Overgaard S, Odgaard A, Roos EM, Skou ST. Are Outcomes From an Exercise Therapy and Patient Education Program for Osteoarthritis Associated With Hip and Knee Replacement Within Two Years? A Register-Based Study of 9,339 Patients With Osteoarthritis. Arthritis Care Res (Hoboken) 2024. [PMID: 38272841 DOI: 10.1002/acr.25303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/21/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The objective of this study was to determine whether short-term outcomes from exercise therapy and patient education for osteoarthritis (OA) are associated with hip or knee replacement within two years. METHODS Individual-level data from the Good Life with osteoArthritis in Denmark (GLA:D) Registry were linked to the Danish National Patient Registry and other national registries. Cox proportional hazards models were used to investigate associations between program outcomes (baseline to three-month changes) and time to primary hip or knee replacement. Patients who did not receive joint replacement were censored at two years, time of death, or emigration. RESULTS A total of 2,304 and 7,035 patients with clinically diagnosed hip and knee OA, respectively, were included. Of these, 30% with hip OA and 10% with knee OA had joint replacement within two years. Postprogram improvements in hip-related quality of life and arthritis self-efficacy (pain subscale) were associated with a reduced hazard of hip replacement (adjusted hazard ratios [HRs] for a 10-unit improvement: 0.74 [95% confidence interval (CI) 0.69-0.80] and 0.90 [95% CI 0.85-0.96], respectively). Improvements in knee pain, knee-related quality of life, and arthritis self-efficacy (pain subscale) were associated with a lower hazard of knee replacement (adjusted HRs for 10-unit improvement: 0.81 [95% CI 0.76-0.86] to 0.90 [95% CI 0.86-0.95], 0.70 [95% CI 0.63-0.78] to 0.79 [95% CI 0.72-0.86], and 0.89 [95% CI 0.83-0.94], respectively). CONCLUSION The magnitude of improvement in key measures after exercise therapy and education was significantly associated with the likelihood of surgery. Progression to hip replacement was three times higher than progression to knee replacement. This information can guide patient-clinician conversations around anticipated program outcomes.
Collapse
Affiliation(s)
| | | | - Dorte T Grønne
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | | | | | - Søren Overgaard
- Copenhagen University Hospital, Bispebjerg, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | - Anders Odgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| |
Collapse
|
4
|
Gates LS, Cherry L, Grønne DT, Roos EM, Skou ST. The prevalence of foot pain and association with baseline characteristics in people participating in education and supervised exercise for knee or hip osteoarthritis: a cross-sectional study of 26,003 participants from the GLA:D® registry. J Foot Ankle Res 2023; 16:83. [PMID: 37993923 PMCID: PMC10666392 DOI: 10.1186/s13047-023-00673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/15/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) affecting the knee or hip is highly prevalent in the general population and has associated high disease burden. Early identification of modifiable risk factors that prevent, limit, or resolve disease symptoms is critical. Foot pain may represent a potentially modifiable factor however little is known about the prevalence of foot pain in people with knee or hip OA nor whether foot pain is associated with clinical characteristics. The main aim of this study was therefore to determine the prevalence of foot pain in people with knee or hip OA attending an education and supervised exercise-based intervention in Denmark (GLA:D®) and determine if baseline demographic or clinical characteristics are associated with foot pain. METHODS Analysis was conducted on baseline data of 26,003 people with symptomatic knee or hip OA completing a pain mannequin as part of the Good Life with osteoArthritis in Denmark (GLA:D®) primary care programme. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated to estimate the strength of association between baseline clinical characteristics (including pain severity in worst knee/hip joint, number of painful knee/hip joints, pain medication use and physical activity level) and the presence of baseline foot pain. RESULTS Twelve percent of participants (n = 3,049) reported foot pain. In those people with index knee OA (n = 19,391), knee pain severity (OR 1.01 CI 1.00, 1.01), number of painful knee/hip joints (OR 1.67 CI 1.58, 1.79), and use of pain medication (OR 1.23 CI 1.12, 1.36) were statistically associated with foot pain. Excluding use of pain medication, similar associations were seen in those with index hip OA. CONCLUSION Twelve percent of people with knee or hip OA participating in GLA:D® had foot pain. Those with worse knee/hip pain, and greater number of painful joints were more likely to report foot pain. This study is the first to demonstrate a significant relationship between clinical characteristics and foot pain in people with knee or hip OA participating in education and supervised exercise. Future investigation should consider the role that foot pain may play on knee and hip related outcomes following therapeutic intervention.
Collapse
Affiliation(s)
- Lucy S Gates
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- School of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Lindsey Cherry
- School of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
- Solent NHS Trust, Southampton, UK.
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark
| |
Collapse
|
5
|
Holm PM, Roos EM, Grønne DT, Skou ST. Online and onsite supervised exercise therapy and education for individuals with knee osteoarthritis - A before and after comparison of two different care delivery models. Musculoskeletal Care 2023; 21:878-889. [PMID: 37016749 DOI: 10.1002/msc.1765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To compare the 3 and 12-month changes on pain, function and quality of life between online and onsite delivery of Good Life with Osteoarthritis in Denmark (GLA:D® ) in individuals with knee osteoarthritis (OA). DESIGN Non-inferior comparison of individuals with knee OA receiving physiotherapist-supervised online (TeleGLA:D) or onsite (GLA:D®) (12 exercise and 2 education sessions). The primary outcome was the baseline-to-3-month change on KOOS-12 summary score. Secondary outcomes were changes in KOOS-12 subscales pain, function and quality of life and pain intensity (Visual Analog Scale (VAS 0-100)) at 3 and 12 months; 40 m fast-paced walk and 30 s chair-stand at 3 months. Using mixed linear regressions, comparisons were adjusted for age, sex, BMI, comorbidities and number of knees and hips with OA. RESULTS Over a 1-year period (May 2020-May 2021), we included data from 3789 participants (3701 GLA:D®; 88 TeleGLA:D). At 3 months, TeleGLA:D showed non-inferior change-scores to GLA:D® on KOOS-12 summary score; adjusted mean difference (90% Confidence Intervals (CI)) -2.40 (-5.55 to 0.75). For secondary outcomes, there was a statistically significant difference in change-scores, favouring TeleGLA:D in gait speed; adjusted mean difference (90%CI) 0.23 m/s (0.18-0.27). TeleGLA:D remained non-inferior to GLA:D® at 12 months. CONCLUSIONS Online delivery of physiotherapist-supervised neuromuscular exercise and education for individuals with knee OA may be non-inferior to traditional onsite delivery in reducing pain and improving function and quality of life. The wide confidence intervals, baseline imbalance, loss to follow-up and the non-randomized design highlight the need for a confirmatory randomized controlled trial.
Collapse
Affiliation(s)
- Paetur M Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Young JJ, Kongsted A, Jensen RK, Roos EM, Ammendolia C, Skou ST, Grønne DT, Hartvigsen J. Characteristics associated with comorbid lumbar spinal stenosis symptoms in people with knee or hip osteoarthritis: an analysis of 9,136 good life with osteoArthritis in Denmark (GLA:D®) participants. BMC Musculoskelet Disord 2023; 24:250. [PMID: 37005607 PMCID: PMC10067254 DOI: 10.1186/s12891-023-06356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Previous studies have found that lumbar spinal stenosis (LSS) often co-occurs with knee or hip OA and can impact treatment response. However, it is unclear what participant characteristics may be helpful in identifying individuals with these co-occurring conditions. The aim of this cross-sectional study was to explore characteristics associated with comorbid symptoms of lumbar spinal stenosis (LSS) in people with knee or hip osteoarthritis (OA) enrolled in a primary care education and exercise program. METHODS Sociodemographic, clinical characteristics, health status measures, and a self-report questionnaire on the presence of LSS symptoms was collected at baseline from the Good Life with osteoArthritis in Denmark primary care program for knee and hip OA. Cross-sectional associations between characteristics and the presence of comorbid LSS symptoms were assessed separately in participants with primary complaint of knee and hip OA, using domain-specific logistic models and a logistic model including all characteristics. RESULTS A total of 6,541 participants with a primary complaint of knee OA and 2,595 participants with a primary complaint of hip OA were included, of which 40% and 50% reported comorbid LSS symptoms, respectively. LSS symptoms were associated with similar characteristics in knee and hip OA. Sick leave was the only sociodemographic variable consistently associated with LSS symptoms. For clinical characteristics, back pain, longer symptom duration and bilateral or comorbid knee or hip symptoms were also consistently associated. Health status measures were not consistently related to LSS symptoms. CONCLUSION Comorbid LSS symptoms in people with knee or hip OA undergoing a primary care treatment program of group-based education and exercise were common and associated with a similar set of characteristics. These characteristics may help to identify people with co-occurring LSS and knee or hip OA, which can be used to help guide clinical decision-making.
Collapse
Affiliation(s)
- James J Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark.
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Ewa M Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Søren T Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, 4200, Denmark
| | - Dorte T Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| |
Collapse
|
7
|
Baumbach L, Grønne DT, Møller NC, Skou ST, Roos EM. Changes in physical activity and the association between pain and physical activity - a longitudinal analysis of 17,454 patients with knee or hip osteoarthritis from the GLA:D® registry. Osteoarthritis Cartilage 2023; 31:258-266. [PMID: 36272673 DOI: 10.1016/j.joca.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Investigate change in physical activity following an 8-week education and exercise therapy program for patients with knee/hip osteoarthritis, focusing on those with low physical activity level. Furthermore, to evaluate associations between changes in pain intensity and physical activity. METHOD Data from the Good Life with osteoArthritis in Denmark (GLA:D®) registry, at baseline, immediately after completion, and 12 months after entering the program was used. Measures of interest were UCLA activity scale (1-10) and Visual Analog Scale for pain intensity (0-100 mm). Changes in physical activity levels (low 1-4, moderate 5-6, and high 7-10) over three time points were investigated. Asymmetric fixed effects regression models were used to evaluate the association between clinically relevant change in pain (≥15 mm) and change in physical activity level from baseline to 12 months. RESULTS 37% with low activity level at baseline (n = 4,836) and 69% of all patients (n = 17,454) reached or maintained at least a moderate physical activity level at follow-ups. Surprisingly, both an improvement (β = 1.44, P < 0.001) and a worsening (β = 1.18, P < 0.001) in pain intensity was associated with increased physical activity in low activity patients. For all patients a similar trend was observed (β = 0.51, P < 0.001 and β = 0.11, P = 0.215, respectively). CONCLUSION In low active knee or hip OA patients, a third of patients participating in an education and exercise therapy program reached and maintained at least a moderate physical activity level for 1 year. The improvement in physical activity was not dependent on pain reduction.
Collapse
Affiliation(s)
- L Baumbach
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - N C Møller
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| |
Collapse
|
8
|
Peat G, Yu D, Grønne DT, Marshall M, Skou ST, Roos EM. Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program. Arthritis Care Res (Hoboken) 2023; 75:136-144. [PMID: 35900880 PMCID: PMC10087615 DOI: 10.1002/acr.24987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate whether adults with potential multiple social disadvantage have poorer outcomes following attendance in an osteoarthritis (OA) management program (OAMP), and if so, what might determine this result. METHODS Among consecutive knee OA attendees of the Good Life With Osteoarthritis in Denmark (GLA:D) OAMP in Denmark we defined a group with potential "intersectional disadvantage" based on self-reported educational attainment, country of birth, and citizenship. Outcomes of this group were compared with GLA:D participants who were native Danish citizens with higher educational attainment. Outcomes were pain intensity, Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale score, and the EuroQol 5-domain instrument in 5 levels (EQ-5D-5L) score at 3 and 12 months. After data preprocessing, we used entropy balancing to sequentially control for differences between the groups in baseline covariates. Mean between-group differences in outcomes were estimated by weighted linear regression. RESULTS Of 18,448 eligible participants, 250 (1.4%) were nonnative/foreign citizens with lower education. After balancing for differences in baseline score and in administrative and demographic characteristics, they had poorer outcomes than higher-educated native Danish citizens on pain intensity and EQ-5D-5L score at both follow-up points (e.g., between-group mean differences in pain visual analog scale [0-100] at 3 and 12 months: 3.4 [95% confidence interval (95% CI) -0.5, 7.3] and 6.2 [95% CI 1.7, 10.7], respectively). Differences in KOOS quality of life subscale score, were smaller or absent. Balancing for differences on baseline score, comorbidity, self-efficacy, and depression had the greatest effect on reducing observed outcome inequalities. CONCLUSION Outcome inequalities widened following OAMP attendance, particularly at longer-term follow-up, but the magnitude of differences was generally modest and inconsistent across outcome measures. Tailoring content to reduce outcome inequalities may be indicated, but improving access appears the greater priority.
Collapse
Affiliation(s)
- George Peat
- School of Medicine, Keele University, Staffordshire, and Sheffield Hallam University, Sheffield, UK
| | - Dahai Yu
- School of Medicine, Keele University, Staffordshire, UK
| | | | | | - Soren T Skou
- University of Southern Denmark and Naestved-Slagelse-Ringsted Hospitals, Odense, Denmark
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Young JJ, Kongsted A, Hartvigsen J, Roos EM, Ammendolia C, Skou ST, Grønne DT, Jensen RK. Associations between comorbid lumbar spinal stenosis symptoms and treatment outcomes in 6,813 patients with knee or hip osteoarthritis following a patient education and exercise therapy program. Osteoarthr Cartil Open 2022; 4:100324. [PMID: 36561495 PMCID: PMC9763512 DOI: 10.1016/j.ocarto.2022.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective People with knee or hip osteoarthritis (OA) can experience comorbid lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. The aim of this study was to investigate associations between comorbid LSS symptoms and changes in pain, function, and quality of life following a patient education and exercise therapy program. Design This was a longitudinal analysis of 6813 participants in the Good Life with osteoArthritis in Denmark (GLA:D®) program; a structured patient education and exercise therapy program for knee and hip OA. Participants were classified as having comorbid LSS symptoms based on self-report symptom items. Linear mixed models were used to assess differences in change in pain, function, and quality of life outcomes (0 worst to 100 best) at 3- and 12-month follow-up. Results 15% and 23% of knee and hip OA participants had comorbid LSS symptoms, respectively. Knee participants with comorbid LSS symptoms had smaller improvement in pain at 3-months (-1.7, 95% CI -3.3 to -0.1) and hip participants with comorbid LSS symptoms had greater improvement in function at 3- (2.5, 95% CI 0.5 to 5.0) and 12-months (3.8, 95% CI 0.9 to 6.6), when compared to those without LSS symptoms. These differences were not clinically significant and no differences in other outcomes were observed. Conclusion Knee or hip OA patients with comorbid LSS symptoms should expect similar improvements in knee- or hip-related pain, function, and quality of life outcomes when undergoing a patient education and exercise therapy program compared to those without LSS symptoms.
Collapse
Affiliation(s)
- James J. Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada,Corresponding author. Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| | - Ewa M. Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Søren T. Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Dorte T. Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| |
Collapse
|
10
|
Selçuk H, Roos EM, Grønne DT, Thorlund JB, Sarı Z, Skou ST. Influence of Self-Reported Knee Instability on Outcomes Following Education and Exercise: A Cohort Study of 2,466 Patients With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022. [PMID: 36373427 DOI: 10.1002/acr.25060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the influence of self-reported knee instability on changes in knee pain and gait speed following patient education and supervised exercise therapy in patients with knee osteoarthritis (OA). METHODS We included patients enrolled in the Good Life With Osteoarthritis in Denmark (GLA:D) program, an 8-week education and supervised neuromuscular exercise program. Patients were classified into 4 groups according to their level of self-reported knee instability (never; rarely; sometimes; most of the time or all the time). Knee pain intensity was evaluated on a 0-100 mm scale and gait speed from the 4 × 10 meters fast-paced walk test at baseline and after the program. Using linear regression, we examined the association between knee instability and the change in pain and gait speed, respectively. Sex, age, body mass index, physical activity level, and previous knee surgery were covariates in adjusted models. RESULTS Among 2,466 patients with knee OA, mean baseline pain and gait speed varied between 38-59 mm and 1.39-1.56 meters/second in patients experiencing no instability and patients experiencing instability most or all the time, respectively. All instability groups improved in pain and gait speed. Compared to the no instability group, patients reporting instability most or all the time experienced larger improvements in pain (4.3 mm [95% confidence interval 1.2, 7.5]), while no difference between instability groups was found for gait speed. CONCLUSION Knee OA patients with self-reported instability seem to benefit even more from a patient education and supervised exercise therapy program than OA patients without instability.
Collapse
Affiliation(s)
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | | | | | | | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| |
Collapse
|
11
|
Johansson MS, Pottegård A, Søndergaard J, Englund M, Grønne DT, Skou ST, Roos EM, Thorlund JB. Chronic opioid use before and after exercise therapy and patient education among patients with knee or hip osteoarthritis. Osteoarthritis Cartilage 2022; 30:1536-1544. [PMID: 35988705 DOI: 10.1016/j.joca.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/10/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate changes in opioid use after supervised exercise therapy and patient education among knee or hip osteoarthritis patients with chronic opioid use. METHOD In this cohort study, we linked data from the Good Life with osteoArthritis in Denmark register (GLA:D®; standardised treatment program for osteoarthritis; January 2013 to November 2018) with national health registries. Among 35,549 patients, 1,262 were classified as chronic opioid users based on amount and temporal distribution of dispensed opioids the year before the intervention. We investigated changes in opioid use, measured as mg oral morphine equivalents (OMEQs), from the year before the intervention to the year after using generalized estimating equations. RESULTS We found a 10% decrease in mg OMEQs from the year before to the year after the intervention (incidence rate ratio [IRR]: 0.90, 95% confidence interval [CI]: 0.86, 0.94). Additional analyses suggested this decrease to be mainly attributable to regulatory actions targeting opioid prescribing during the study period (IRR among patients participating in the intervention before: 0.98 [95% CI: 0.89, 1.07] vs after: 0.83 [0.74, 0.93] regulatory actions). In a random general population sample of matched chronic opioid users, a similar opioid use pattern was observed over time, further supporting the impact of regulatory actions on the opioid use in the study population. CONCLUSION Among patients with knee or hip osteoarthritis and chronic opioid use, a standardised treatment program did not change opioid use when regulatory changes in opioid prescribing were taken into account.
Collapse
Affiliation(s)
- M S Johansson
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - A Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - M Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - J B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
12
|
Perruccio AV, Roos EM, Skou ST, Grønne DT, Davis AM. Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:1140-1146. [PMID: 35587461 DOI: 10.1002/acr.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To understand factors associated with pain intensity responder status following nonsurgical hip osteoarthritis (OA) intervention, according to sex. METHODS Data were from individuals with hip OA participating in the Danish Good Life With Osteoarthritis in Denmark 8-week education and exercise program. The following factors were recorded at program entry: age; education; mental well-being; comorbidities; body mass index; symptoms in hip, knee, and low back; and program-specific factors including education sessions, former participant lectures, and supervised exercise sessions. Pain intensity was recorded at baseline and at month 3 (post-program) on a 0-100-mm visual analog scale. Response was defined as pain intensity improvement of ≥30% from baseline to post-program. Logistic regression was used and conducted separately in male and female subjects. RESULTS The sample included 791 men and 2,253 women. Female subjects had a mean baseline pain score of 47.2 of 100 (95% confidence interval [95% CI] 46.4-48.1) and male subjects had a score of 41.7 (95% CI 40.3-43.1). By post-program, the proportion of pain responders was 50.4% among women and 45.8% among men (difference P = 0.025). Among women, program-specific factors (attending former participant lectures and more supervised exercise sessions) were positively associated with pain response, as were better mental well-being and fewer comorbidities, while symptoms in other joints/sites were associated with a decreased likelihood of response. Among men, program-specific factors were not associated with response, while better mental well-being and fewer comorbidities were associated with being a responder. CONCLUSION Findings suggest that the influence of some factors on pain response differ for male and female subjects and point to a potential need for targeted approaches for men and women who may require different key messages/approaches from health care providers.
Collapse
Affiliation(s)
- Anthony V Perruccio
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | | | - Aileen M Davis
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Roos EM, Grønne DT, Thorlund JB, Skou ST. Knee and hip osteoarthritis are more alike than different in baseline characteristics and outcomes: a longitudinal study of 32,599 patients participating in supervised education and exercise therapy. Osteoarthritis Cartilage 2022; 30:681-688. [PMID: 35176479 DOI: 10.1016/j.joca.2022.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Compare baseline characteristics and change in outcomes in patients with symptomatic knee or hip OA participating in patient education and exercise therapy. DESIGN Longitudinal cohort study. Good Life with osteoArthritis in Denmark (GLA:D®) is an 8-week patient education and supervised exercise program delivered by certified clinicians. Changes in pain intensity, Knee injury/Hip disability Osteoarthritis Outcome Scores' subscale Quality of Life (K/HOOS QOL), EuroQoL 5-Dimensions 5-Level (EQ-5D) and 40 m walk test at ∼3 and 12 months were compared between knee and hip patients. RESULTS 24,241 knee and 8,358 hip patients were included, with response rates of 75% and 60% at ∼3 and 12 months. Age, gender, symptom duration, pain medication use, pain intensity, physical function and quality of life were alike. More knee than hip patients were obese and had bilateral symptoms. At 3 months, clinically relevant improvements were seen in both knee and hip OA patients with clinically irrelevant between groups differences; 2.1 (1.5; 2.8) mm in pain intensity, -1.1 (-1.5; -0.7) point in K/HOOS QOL score, -0.010 (-0.013; -0.007) in EQ-5D index score and -0.02 (-0.02; -0.01) m/sec in walking speed. At 12 months the slight immediate differences were equalized. CONCLUSION Patients presenting with knee and hip OA in primary care were on average more alike than different. Following treatment, clinically relevant improvements were seen in both knee and hip OA patients at 3 and 12 months. Patients with knee and hip OA should be prioritized alike for treatment with patient education and supervised exercise therapy.
Collapse
Affiliation(s)
- E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.
| | - J B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Research Unit for General Practice, Department of Public Health, University of Southern Denmark.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| |
Collapse
|
14
|
Grønne DT, Roos EM, Ibsen R, Kjellberg J, Skou ST. Cost-effectiveness of an 8-week supervised education and exercise therapy programme for knee and hip osteoarthritis: a pre-post analysis of 16 255 patients participating in Good Life with osteoArthritis in Denmark (GLA:D). BMJ Open 2021; 11:e049541. [PMID: 34903537 PMCID: PMC8672017 DOI: 10.1136/bmjopen-2021-049541] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate 1-year cost-effectiveness of an 8-week supervised education and exercise programme delivered in primary care to patients with symptomatic knee or hip osteoarthritis (OA). DESIGN A registry-based pre-post study linking patient-level data from the Good Life with osteoArthritis in Denmark (GLA:D) registry to national registries in Denmark. SETTING AND PARTICIPANTS 16 255 patients with symptomatic knee or hip OA attending GLA:D. INTERVENTION GLA:D is a structured supervised patient education and exercise programme delivered by certified physiotherapists and implemented in Denmark. OUTCOME MEASURES Adjusted healthcare costs per Quality-Adjusted Life Year (QALY) gained from baseline to 1 year (ratio of change in healthcare costs to change in EuroQoL 5-Dimensions 5-Level questionnaire (EQ-5D)). All adjusted measures were estimated using a generalised estimating equation gamma regression model for repeated measures. Missing data on EQ-5D were imputed with Multiple Imputations (3 months: 23%; 1 year: 39 %). RESULTS Adjusted change in healthcare cost was 298€ (95% CI: 206 to 419) and 640€ (95% CI: 400 to 1009) and change in EQ-5D was 0.035 (95% CI: 0.033 to 0.037) and 0.028 (95% CI: 0.025 to 0.032) for knee and hip patients, respectively. Hence estimated adjusted healthcare costs per QALY gained was 8497€ (95% CI: 6242 to 11 324) for knee and 22 568€ (95% CI: 16 000 to 31 531) for hip patients. In patients with high compliance, the adjusted healthcare costs per QALY gained was 5438€ (95% CI: 2758 to 9231) for knee and 17 330€ (95% CI: 10 041 to 29 364) for hip patients. Healthcare costs per QALY were below conventional thresholds for willingness-to-pay at 22 804€ (20 000£) and 43 979€ (US$50 000), except the upper limit of the 95% CI for hip patients which was in between the two thresholds. CONCLUSIONS A structured 8-week supervised education and exercise programme delivered in primary care was cost-effective at 1 year in patients with knee or hip OA supporting large-scale implementation in clinical practice.
Collapse
Affiliation(s)
- Dorte T Grønne
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| |
Collapse
|
15
|
Young JJ, Hartvigsen J, Roos EM, Ammendolia C, Kongsted A, Skou ST, Grønne DT, Jensen RK. Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain: a cross-sectional study of 10,234 participants in primary care. Osteoarthritis Cartilage 2021; 29:1515-1520. [PMID: 34343677 DOI: 10.1016/j.joca.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate: the proportion of people reporting symptoms associated with lumbar spinal stenosis (LSS) in primary care programs for knee or hip osteoarthritis (OA) or persistent low back pain (LBP) and; the prevalence of self-reported clinical LSS in these three cohorts, according to two sets of adapted criteria. METHOD A cross-sectional analysis of baseline data from the Good Life with osteoArthritis in Denmark primary care programs. Self-report LSS symptom questions were administered to participants with knee OA, hip OA, and persistent LBP. The prevalence of eleven LSS symptoms and clinical LSS were calculated for each cohort. RESULTS A total of 10,234 participants were included in the analysis. A similar proportion of participants in each cohort were female (69%), with a 6- and 7-year older mean age in the knee and hip cohorts compared to the back cohort. A greater proportion of participants with LBP reported LSS symptoms (range 11-71%) than in the hip (11-50%) and knee (8-40%) cohorts. This pattern was observed for all but one symptom. The same pattern was observed for the prevalence of clinical LSS with less than 10% of people in each cohort satisfying the clinical criteria. CONCLUSION Self-reported LSS symptoms are commonly reported by people treated in primary care for knee or hip OA, although not as frequently as reported by those with LBP. Despite symptoms of LSS being common, only a small proportion of people were classified as having self-reported clinical LSS.
Collapse
Affiliation(s)
- J J Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada.
| | - J Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Chiropractic Knowledge Hub, Odense, 5230, Denmark.
| | - E M Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
| | - C Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - A Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Chiropractic Knowledge Hub, Odense, 5230, Denmark.
| | - S T Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, 4200, Denmark.
| | - D T Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
| | - R K Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Chiropractic Knowledge Hub, Odense, 5230, Denmark.
| |
Collapse
|
16
|
Selçuk H, Roos EM, Grønne DT, Ernst MT, Skou ST. Agreement Between Self-Reported Information and Administrative Data on Comorbidities, Imaging and Treatment in Denmark - A Validation Study of 38,745 Patients with Knee or Hip Osteoarthritis. Clin Epidemiol 2021; 13:779-790. [PMID: 34512031 PMCID: PMC8416180 DOI: 10.2147/clep.s309364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate self-reported information obtained from patients with knee or hip osteoarthritis (OA) in primary care against administrative data from the three national Danish registries. Patients and Methods We compared the baseline and 12-month follow-up data from 38,745 patients with knee or hip OA participating in the Good Life with osteoArthritis in Denmark (GLA:D®) program with registry-based data on joint surgeries, pain medication dispensing, radiographs, and hospital diagnoses. Agreement was calculated using Cohen's Kappa (k) and percentage agreement, both with 95% CI. Results There was a moderate agreement between self-report and registry-based data for previous knee surgery (k=0.58, 84.99%) and a substantial agreement for previous hip surgery (k=0.73, 97.05%). Agreement varied from 0.05 to 0.95 and 84.99% to 99.94% for different types of surgeries with lowest agreement for collateral ligament surgery (k=0.05, 99.82%) and highest agreement for joint replacement (k=0.95, 99.54% for knee; k=0.95, 99.48% for hip). There was a moderate agreement (k=0.41, 81.59%) for knee and a slight agreement (k=0.20, 64.79%) for hip radiographs. Agreement varied from 0.01 to 0.53 and 65.39% to 99.90% for pain medication with lowest agreement for topical NSAID (k=0.01, 95.00%) and highest agreement for opioids (k=0.53, 92.56%). For comorbidities, agreement varied from 0.14 to 0.90 and 78.07% to 98.91%, with lowest agreement for anemia or other blood disease (k=0.14, 97.63%) and highest agreement for diabetes (k=0.90, 98.73%). Conclusion As the most common types of pain medication used by patients with OA can be bought over-the-counter and as most OA patients are treated in primary care, which is often not covered by national registries, self-report of pain medication use and comorbidities is preferred but cannot be sufficiently validated against registry-based data. Future studies collecting self-reported information on joint surgery and pain medication from patients with OA should use a less detailed categorization to improve accuracy.
Collapse
Affiliation(s)
- Halit Selçuk
- Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin T Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| |
Collapse
|
17
|
Pihl K, Roos EM, Taylor RS, Grønne DT, Skou ST. Prognostic Factors for Health Outcomes After Exercise Therapy and Education in Individuals With Knee and Hip Osteoarthritis With or Without Comorbidities: A Study of 37,576 Patients Treated in Primary Care. Arthritis Care Res (Hoboken) 2021; 74:1866-1878. [PMID: 34085408 PMCID: PMC7613737 DOI: 10.1002/acr.24722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify prognostic factors for health outcomes following an 8-week supervised exercise therapy and education program for individuals with knee and hip osteoarthritis (OA) alone or with concomitant hypertension, heart or respiratory disease, diabetes mellitus, or depression. METHODS We included individuals with knee and/or hip OA from the Good Life With OsteoArthritis in Denmark (GLA:D) program. GLA:D consists of 2 patient education sessions and 12 supervised exercise therapy sessions. Before GLA:D, participants self-reported any comorbidities and were categorized into 8 comorbidity groups. Twenty-one potential prognostic factors (demographic information, clinical data, and performance-based physical function) gathered from participants and clinicians before the program were included. Outcomes were physical function using the 40-meter Fast-Paced Walk Test (FPWT), health-related quality of life using the 5-level EuroQol 5-domain (EQ-5D-5L) index score, and pain intensity using a visual analog scale (VAS; range 0-100) assessed before and immediately after the GLA:D program. Within each comorbidity group, associations of prognostic factors with outcomes were estimated using multivariable linear regression. RESULTS Data from 35,496 (40-meter FPWT) and 37,576 (EQ-5D-5L and VAS) participants were included in the analyses. Clinically relevant associations were demonstrated between age, self-efficacy, self-rated health, and pain intensity and change in 40-meter FPWT, EQ-5D-5L, or VAS scores across comorbidity groups. Furthermore, anxiety, education, physical function, and smoking were associated with outcomes among subgroups having depression or diabetes mellitus in addition to OA. CONCLUSION Age, self-efficacy, self-rated health, and pain intensity may be prognostic of change in health outcomes following an 8-week exercise therapy and patient education program for individuals with OA, irrespective of comorbidities.
Collapse
Affiliation(s)
- Kenneth Pihl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, UK,Institute of Health Services Research, University of Exeter Medical School, UK
| | - Dorte T Grønne
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| |
Collapse
|
18
|
Roos EM, Grønne DT, Skou ST, Zywiel MG, McGlasson R, Barton CJ, Kemp JL, Crossley KM, Davis AM. Immediate outcomes following the GLA:D® program in Denmark, Canada and Australia. A longitudinal analysis including 28,370 patients with symptomatic knee or hip osteoarthritis. Osteoarthritis Cartilage 2021; 29:502-506. [PMID: 33561542 DOI: 10.1016/j.joca.2020.12.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report outcomes across three countries for patients with symptomatic knee or hip OA attending the evidence-based education and exercise therapy program Good Life with osteoArthritis from Denmark (GLA:D®). DESIGN GLA:D® is a structured treatment program including 2-3 patient education sessions and 12 supervised exercise sessions delivered over 8 weeks by certified health care practitioners. The program was introduced in Denmark in 2013, in Canada 2015 and in Australia 2016. Absolute mean change in pain intensity, number of chair stands in 30 s, 40 m walk test time and Knee injury and Osteoarthritis Outcome Score (KOOS)/Hip dysfunction and Osteoarthritis Outcome Score (HOOS) QOL subscale scores from baseline to immediately after treatment were reported as means and 95 % CIs and proportion of responders for each country. RESULTS Patients from the three countries improved 26-33% in mean pain intensity, 8-12% in walking speed, 18-30% in chair stand ability and 12-26% in joint-related quality of life from baseline to immediately after treatment, with no clinically relevant differences between patients with hip and knee OA. These improvements correspond with moderate to large within-group effect sizes and 43-47 % of the patients experienced clinically relevant pain reductions. CONCLUSION About half or more of patients across the three countries were categorized as responders for pain and objective function following the implementation of GLA:D®. These findings indicate positive patient outcomes associated with GLA:D® participation across varying health care systems from implementation of guideline-based patient education and exercise therapy for knee and hip OA.
Collapse
Affiliation(s)
- E M Roos
- Center for Muscle and Joint Health, University of Southern, Denmark.
| | - D T Grønne
- Center for Muscle and Joint Health, University of Southern, Denmark
| | - S T Skou
- Center for Muscle and Joint Health, University of Southern, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| | - M G Zywiel
- Arthritis Program and Krembil Research Institute, University Health Network and Department of Surgery and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | | | - C J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Applied Health, Human Services and Sport, La Trobe University, Australia; Department of Surgery, St Vincents's Hospital, University of Melbourne, Australia
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Applied Health, Human Services and Sport, La Trobe University, Australia
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Applied Health, Human Services and Sport, La Trobe University, Australia
| | - A M Davis
- Arthritis Program and Krembil Research Institute, University Health Network and Department of Surgery and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| |
Collapse
|
19
|
Young JJ, Skou ST, Koes BW, Grønne DT, Roos EM. Proportion of patients with hip osteoarthritis in primary care identified by differing clinical criteria: a cross-sectional study of 4699 patients. Osteoarthritis and Cartilage Open 2020; 2:100111. [DOI: 10.1016/j.ocarto.2020.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022] Open
|
20
|
Baumbach L, List M, Grønne DT, Skou ST, Roos EM. Individualized predictions of changes in knee pain, quality of life and walking speed following patient education and exercise therapy in patients with knee osteoarthritis - a prognostic model study. Osteoarthritis Cartilage 2020; 28:1191-1201. [PMID: 32561455 DOI: 10.1016/j.joca.2020.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To facilitate shared decision-making for patients with knee osteoarthritis (OA), we aimed at building clinically applicable models to predict the individual change in pain intensity (VAS scale 0-100), knee-related quality of life (QoL) (KOOS QoL score 0-100) and walking speed (m/sec) immediately following two educational and 12 supervised exercise therapy sessions. METHODS We used data from patients with knee OA from the 'Good Life with osteoArthritis in Denmark' (GLA:D®) registry (n = 6,767). From 51 patient characteristics, we selected the best performing variables to predict the outcomes via random forest regression. We evaluated model performance via R2. Lastly, we validated and compared our models with the average improvements via the mean differences in an independent validation data set from the GLA:D® registry (n = 2,896) collected 1 year later than the data used to build the models. RESULTS Validating our models including the best performing variables yielded R2s of 0.34 for pain intensity, 0.18 for knee-related QoL, and 0.07 for walking speed. The absolute mean differences between model predictions and the true outcomes were 14.65 mm, 10.32 points, and 0.14 m/s, respectively, and similar to the absolute mean differences of 17.64, 11.28 and 0.14 observed when we subtracted the average improvements from the true outcomes. CONCLUSION Despite including 51 potential predictors, we were unable to predict changes in individuals' pain intensity, knee-related QoL and walking speed with clinically relevant greater precision than the respective group average outcomes. Therefore, average prediction values can be used to inform patients about expected outcomes.
Collapse
Affiliation(s)
- L Baumbach
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.
| | - M List
- Big Data in BioMedicine Group, Chair of Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, 85354, Freising, Germany.
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark.
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.
| |
Collapse
|
21
|
Muckelt PE, Roos EM, Stokes M, McDonough S, Grønne DT, Ewings S, Skou ST. Comorbidities and their link with individual health status: A cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care. J Comorb 2020; 10:2235042X20920456. [PMID: 32489945 PMCID: PMC7238776 DOI: 10.1177/2235042x20920456] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/08/2020] [Indexed: 12/20/2022]
Abstract
Objectives: Robust data on the impact of comorbidities on health in people with osteoarthritis (OA) are lacking, despite its potential importance for patient management. Objectives were to determine coexisting conditions in people with OA in primary care and whether more comorbidities were linked with individual health status. Methods: A retrospective analysis of 23,892 patients with knee and hip OA was conducted to determine comorbidities present (number/clusters) and how these linked with pain intensity (0–100), widespread pain (site numbers), medication usage (paracetamol, nonsteroidal anti-inflammatory drugs, opioids), quality of life EuroQol five dimension scale (EQ-5D), and physical function (walking speed) using independent t-tests or χ2 test. Results: Sixty-two percent of people with OA treated in primary care had at least one comorbidity; hypertension (37%), heart disease (8%), and diabetes (7%) being most common. Outcome measures worsened with more comorbidities (0–4+ comorbidities); pain intensity [mean (SD)] 46(22)–57(21); number of painful sites 3.7(3.0)–6.3(5.4); quality of life 0.73(0.10)–0.63(0.15); walking speed 1.57 m/s (0.33)–1.24 m/s (0.31), while the proportion of people using pain medication increased from 0 to 2 comorbidities (58–69%; p < 0.001), with an increase in opioid use from 4.6% to 19.5% with more comorbidities (0–4+ comorbidities). Conclusion: Most people with knee or hip OA in primary care have at least one other long-term condition. A greater number of comorbidities is linked with worsening health, highlighting the importance of screening for comorbidities when treating patients with OA. It is important for clinicians to consider how OA treatments will interact and affect other common comorbidities.
Collapse
Affiliation(s)
- Paul Edward Muckelt
- School of Health Sciences, University of Southampton, Southampton, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - M Stokes
- School of Health Sciences, University of Southampton, Southampton, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK
| | - S McDonough
- School of Health Sciences, Institute of Nursing and Health Research Ulster University.,School of Physiotherapy, University of Otago, Dunedin, New Zealand.,School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - S Ewings
- School of Health Sciences, University of Southampton, Southampton, UK
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
| |
Collapse
|