Wednesday, January 18, 2017

Managing pain and function associated with hip or knee osteoarthritis

No intervention, whether patient-based, provider-based, or a combination of the two, provided improvements over usual care for patients with knee osteoarthritis. These findings contradict conclusions from an earlier study suggesting that a combined intervention provided modest improvements in function and activity compared with usual care. The results of a cluster randomized trial are published in Annals of Internal Medicine.

Managing pain and function associated with hip or knee osteoarthritis requires both medical and behavioral strategies, but recommended therapies are underused. A single-site study conducted in a Department of Veterans Affairs medical center showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.

To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes, researchers randomly assigned 537 outpatients with symptomatic hip or knee osteoarthritis at 10 Duke University Health System community-based primary care clinics to receive care using one of the three interventions. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through electronic medical records. The patient-provider intervention combined both approaches.

At 12 months, none of the osteoarthritis intervention groups showed greater improvements in outcomes compared with usual care. The authors note that the intervention was low-intensity. The authors suggest that higher-intensity interventions are needed to make more meaningful improvements in outcomes.

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