POS1080 IMPLEMENTING OA TREATMENT RECOMMENDATIONS IN PRIMARY CARE POSTPONED JOINT REPLACEMENT IN HIP AND KNEE JOINTS - 8 YEAR FOLLOW-UP OF A CLUSTER RANDOMIZED CONTROLLED TRIAL

Osteras, N.; Moseng, T.; Van Bodegom-Vos, L.; Dziedzic, K.; Natvig, B.; Røtterud, J.H.; Vliet Vlieland, T.P.M.; Fenstad, A.M.; Furnes, O.; Hagen, K.B.

Abstract

Background:
To improve quality of hip and knee osteoarthritis (OA) management a structured model of care was developed based on international treatment recommendations. The model was implemented among general practitioners (GPs) and physiotherapists (PTs) in primary care in a cluster randomized trial (cRCT). Previous results showed that the patients in the intervention group were more likely to be treated according to international OA guidelines, to fulfil recommendations for physical activity, to report greater satisfaction with care, and were less likely to receive total joint replacement (TJR) surgery compared to the patients in the usual care control group at the 12-month follow-up. Furthermore, the structured model of care was shown to be a cost-effective alternative compared to usual care for people with hip and knee OA.

Objectives:
The current study aimed to compare the proportion of patients having received TRJ surgery at the 8 years follow-up, compare the survival (no TJR surgery) rate over time, and the mean number of days from baseline to TJR surgery in the two groups.

Methods:
A cRCT with stepped-wedge cohort design was conducted in six Norwegian neighbouring municipalities (clusters) between January 2015 and October 2017. The model of OA care was implemented in one municipality at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for GPs and PTs with an update on OA treatment recommendations. The GPs were instructed to explain the OA diagnosis and treatment alternatives, provide pharmacological treatment when appropriate, and suggest referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours (AktivA). This was followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (AktivA). An optional 10-hours Healthy Eating Program was also available. Patient participants included people aged 45 years and over with symptomatic hip or knee OA. After the 12-month follow-up, the control group were invited to a 3-hours OA education programme provided by the project group (39% attended). Data on TJR surgical procedures was extracted from the Norwegian Arthroplasty Register in November 2023. Only the first primary TJR after baseline per patient was included in the analyses. Cox regression survival curves adjusted for age and sex were plotted to compare the survival rate (no TJR) in the two groups. Between-group difference in number of days from baseline to surgery was analysed in a linear regression model among those that had received TJR surgery.

Results:
At baseline, the mean age of the 393 included patients was 63 years (SD 9.6) and 70% (n=279) were women. Among these, 109 patients were recruited during the control periods (control group), and 284 patients were recruited during interventions periods (intervention group). The mean follow-up time from baseline to extraction of register data was 2903 days (SD 163), which is 7.9 years. In total 103 TJR surgeries were performed during this period. Of these, 54 were in the hip and 49 in the knee joint, respectively. The proportion of patients that had received TJR, was the similar for the two groups (26%). The within-group proportion of hip TJR was higher in the control group (20/28, 71%) compared to the intervention group (34/75, 45%) (X2: 5.5, p< 0.05). The survival rate was higher for the intervention group compared to the control group up until 7-8 years (Figure 1). Among those who received TJR surgery, the mean (SD) number of days from baseline to the first primary TJR surgery was 700 (626) in the control group and 1296 (823) in the intervention group (Between-group difference: 596 days, 95% CI 255, 936, p<0.001).

Conclusion:
While the TJR surgery rate was similar in the two groups after 8 years, the survival rate was higher in the intervention group over time and time to TJR surgery was substantially increased in the intervention group compared to the control group.

Citation

Osteras, N., Moseng, T., Van Bodegom-Vos, L., Dziedzic, K., Natvig, B., Røtterud, J., …Hagen, K. (in press). POS1080 IMPLEMENTING OA TREATMENT RECOMMENDATIONS IN PRIMARY CARE POSTPONED JOINT REPLACEMENT IN HIP AND KNEE JOINTS - 8 YEAR FOLLOW-UP OF A CLUSTER RANDOMIZED CONTROLLED TRIAL. Annals of the Rheumatic Diseases, 83, 659-660. https://doi.org/10.1136/annrheumdis-2024-eular.1530

• Journal Article Type: Meeting Abstract
• Conference Name: EULAR 2024
• Conference Location: Vienna, Austria
• Acceptance Date: Jun 1, 2024
• Online Publication Date: Jan 2, 2025
• Deposit Date: Jan 16, 2025
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 83
• Pages: 659-660
• DOI: https://doi.org/10.1136/annrheumdis-2024-eular.1530
• Public URL: https://keele-repository.worktribe.com/output/1046837
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S0003496724159092