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| 2. |
- Cronström, Anna, et al.
(författare)
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Factors associated with patients' willingness to consider joint surgery after completion of a digital osteoarthritis treatment program : A prospective cohort study
- 2019
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Ingår i: Arthritis care and research : the official journal of the Arthritis Health Professions Association. - : Wiley. - 2151-464X. ; 71:9, s. 1194-1201
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine patient willingness and possible shift in willingness for surgery and to investigate factors associated with this shift, following participation in the digital non-surgical osteoarthritis (OA) treatment program Joint Academy.METHODS: 458 individuals (mean age 62±5.6 years, 67% women) with diagnosed hip or knee were evaluated after six weeks in Joint Academy, comprising education and exercise as well as asynchronous chat with a physical therapist. Data describing joint pain, health-related quality of life (EQ-5D-3L), walking difficulties, 30-second Chair Stand Test (30CST) and willingness to consider surgery were collected at baseline and at six weeks.RESULTS: At follow-up, 31% of those willing to consider surgery at baseline no longer considered surgery. Of those who were unwilling to consider surgery at baseline, 6% re-considered and considered surgery at follow-up. Less pain and a higher EQ-5D-3L index at six weeks were associated with the shift from being willing to unwilling to consider surgery at follow-up (OR=0.67-1.64, p<0.05). Worse pain, a lower EQ-5D-3L index and having walking difficulties at six weeks, and a lower pain and EQ-5D-3L index improvement were associated with the shift from being unwilling to willing to consider surgery at six weeks (OR=0.51-4.30, p<0.005).CONCLUSIONS: Evidence-based non-surgical OA treatment, at least delivered digitally, may reduce the need for surgery and should therefore be offered as the first-line treatment option to patients with hip and knee OA. Result also supports the notion that such treatment programs have the potential to improve selection of patients for total joint replacement. This article is protected by copyright. All rights reserved.
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| 3. |
- Cronström, Anna, et al.
(författare)
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"I was considering surgery because I believed that was how it was treated" : a qualitative study on willingness for joint surgery after completion of a digital management program for osteoarthritis.
- 2019
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier. - 1063-4584 .- 1522-9653. ; 27:7, s. 1026-1032
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore, using a qualitative approach, reasons for patients' continued willingness or their shift in willingness for total joint replacement (TJR) surgery, following participation in Joint Academy, a Swedish, digital, non-surgical treatment program for osteoarthritis (OA).DESIGN: Nineteen patients with hip or knee OA were interviewed after finishing their first six weeks in the treatment program, using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using a systematic text condensation method.RESULTS: Analysis of the interview data revealed three main categories of reasons provided for the participants' decisions regarding surgery: 1) Various reasons for participating in Joint Academy with three sub-categories: (a) longstanding pain affects daily life, (b) last chance for improvement and (c) mandatory treatment to be eligible for TJR; 2) Willingness for TJR following treatment, which included four sub-categories: (a) surgery - the last resort, (b) reduced pain and improved functioning, (c) no perceived improvements after treatment, and (d) trust in healthcare providers; and 3) Expectations of TJR. The shift in willingness towards or away from TJR was mainly due to the perceived success of Joint Academy in improving their functioning.CONCLUSION: Several patients reconsidered their options and had changed their attitude to TJR after participation in a digital program aimed at reducing OA symptoms and improving functioning. These results highlight the importance of providing patients with adequate information about non-surgical management options to facilitate shared decision-making, and possibly reduce the need for surgery.
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| 4. |
- Cronström, Anna, et al.
(författare)
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"I was considering surgery because I believed that was how it was treated" : a qualitative study on willingness for joint surgery after completion of a digital management program for osteoarthritis.
- 2019
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Ingår i: Osteoarthritis and Cartilage. - : W.B. Saunders Ltd. - 1063-4584 .- 1522-9653. ; 27:7, s. 1026-1032
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore, using a qualitative approach, reasons for patients' continued willingness or their shift in willingness for total joint replacement (TJR) surgery, following participation in Joint Academy, a Swedish, digital, non-surgical treatment program for osteoarthritis (OA). DESIGN: Nineteen patients with hip or knee OA were interviewed after finishing their first six weeks in the treatment program, using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using a systematic text condensation method. RESULTS: Analysis of the interview data revealed three main categories of reasons provided for the participants' decisions regarding surgery: 1) Various reasons for participating in Joint Academy with three sub-categories: (a) longstanding pain affects daily life, (b) last chance for improvement and (c) mandatory treatment to be eligible for TJR; 2) Willingness for TJR following treatment, which included four sub-categories: (a) surgery - the last resort, (b) reduced pain and improved functioning, (c) no perceived improvements after treatment, and (d) trust in healthcare providers; and 3) Expectations of TJR. The shift in willingness towards or away from TJR was mainly due to the perceived success of Joint Academy in improving their functioning. CONCLUSION: Several patients reconsidered their options and had changed their attitude to TJR after participation in a digital program aimed at reducing OA symptoms and improving functioning. These results highlight the importance of providing patients with adequate information about non-surgical management options to facilitate shared decision-making, and possibly reduce the need for surgery.
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| 5. |
- Cronström, Anna, et al.
(författare)
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'I would never have done it if it hadn't been digital' : a qualitative study on patients' experiences of a digital management programme for hip and knee osteoarthritis in Sweden.
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the experiences of a digital management programme for hip and knee osteoarthritis (OA), including education and exercises as well as an option to chat with an assigned physical therapist for feedback, questions and support. SETTING: This study was conducted at a regional hospital in the southern part of Sweden. METHODS: Nineteen patients (10 women), median age of 66 (q1-q3, 57-71) years, with confirmed hip or knee OA were interviewed after completing their first 6 weeks in the programme, using a semistructured interview guide. The interviews were transcribed verbatim and were qualitatively analysed using systematic text condensation. RESULTS: Three categories emerged during the interviews:(1) Management options for mitigating the consequences of OA; (2) Experiences of the digital programme and (3) Perceived effects of the digital programme over time. The participants had mostly positive experiences of the programme. Particularly important for these experiences were no waiting list, the flexibility of taking part in the programme with regards to location and time and the possibility to have daily contact with a physical therapist. These aspects were also emphasised as advantages compared with traditional care. CONCLUSIONS: Digital management of OA, including education and exercise, was experienced as a valid alternative to traditional treatment in enabling the implementation of OA guidelines in a wider community. Easy access, exercising at one's own convenience, flexible options, daily follow-up and support by a physical therapist were mentioned as the most important features. In addition, the results will contribute to further development and improvement of digital OA management programmes.
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| 7. |
- Cronström, Anna, et al.
(författare)
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Interpretation threshold values for patient-reported outcomes in patients participating in a digitally delivered first-line treatment program for hip or knee osteoarthritis
- 2023
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Ingår i: Osteoarthritis and Cartilage Open. - : Elsevier. - 2665-9131. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Establish proportions of patients reporting important improvement, acceptable symptoms and treatment failure and define interpretation threshold values for pain, patient-reported function and quality-of-life after participating in digital first-line treatment including education and exercise for hip and knee osteoarthritis (OA).Methods: Observational study. Responses to the pain Numeric Rating Scale (NRS, 0-10 best to worst), Knee injury and Osteoarthritis Outcome Score 12 (KOOS-12) and Hip disability and Osteoarthritis Outcome Score 12 (HOOS-12, both 0-100 worst to best) were obtained for 4383 (2987) and 20341 (1264) participants with knee (hip) OA at 3 and 12 months post intervention.. Threshold values for Minimal Important Change (MIC), Patient Acceptable Symptom State (PASS) and Treatment Failure (TF) were estimated using anchor-based predictive modeling.Results: 70–85% reported an important improvement in pain, function and quality of life after 3 and 12 months follow-up. 42% (3 months) and 51% (12 months) considered their current state as satisfactory, whereas 2-4% considered treatment failed. MIC values were -1 (NRS) and 0-4 (KOOS/HOOS-12) across follow-ups and joint affected. PASS threshold value for NRS was 3, and 53–73 for the KOOS/HOOS-12 subscales Corresponding values for TF were 5 (NRS) and 34–55 (KOOS/HOOS-12). Patients with more severe pain at baseline had higher MIC scores and accepted poorer outcomes at follow-ups.Conclusion: Threshold estimates aid in the interpretation of outcomes after first-line OA interventions assessed with NRS Pain and KOOS/HOOS-12. Baseline pain severity is important to consider when interpreting threshold values after first-line interventions in these patients.
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- Dahlberg, Leif E., et al.
(författare)
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Improving osteoarthritis care by digital means - Effects of a digital self-management program after 24- or 48-weeks of treatment
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:3
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Tidskriftsartikel (refereegranskat)abstract
- Background Osteoarthritis (OA) is highly prevalent in older adults and a growing cause of disability. Easily accessible first-line treatment of OA is increasingly important. Digital self-management programs have in recent years become available. Evidence of short-term effects of such programs are abundant, yet reports on long-term benefits and adherence to treatment are scarce. The current study’s objective was to investigate the long-term pain and function outcomes of people with hip or knee OA participating in a digital self-management programme. Methods and findings In this longitudinal cohort study, individuals with hip and knee OA, from the register of a digital self-management program and with 0-24-week (n = 499) or 0-48-week adherence (n = 138), were included. The treatment effect in terms of monthly pain (NRS, 0–10 worst to best) and physical function (30-second chair stand test (30CST), number of repetitions) change were investigated using a mixed model, controlling for the effect of age, body mass index (BMI), gender and index joint. For the 24-week sub-sample, pain NRS decreased monthly by -0.43 units (95% CI -0.51, -0.35, mean knee pain from 5.6 to 3.1, and hip pain from 5.9 to 3.8) and 30CST repetitions increased monthly by 0.76 repetitions (95% CI 0.64, 0.89 mean for knee from 10.0 to 14.3, and for hip from 10.9 to 14.8). For the 48-week sub-sample, pain decreased monthly by -0.39 units (95% CI -0.43, -0.36, mean knee pain from 5.7 to 3.2, and hip pain from 5.8 to 3.8), and repetitions increased by 0.72 repetitions (95% CI 0.65, 0.79, mean repetitions for knee from 10.3 to 14.4, and for hip from 11.1 to 14.9). There were no clinically relevant effects on the improvement of pain or function by any covariate (age, sex, index joint). The lack of a control group and randomization limit our ability to explain the mechanisms of the observed results. Conclusions Continuously participating in a digital OA treatment program for 6 or 12 months was associated with a clinically important decrease in joint pain and increased physical function, in hip and knee OA. Future research should follow OA-related outcomes in participants that end their treatment to explore when and why that decision was made.
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| 9. |
- Dell'Isola, Andrea, et al.
(författare)
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Factors Associated With the Outcome of a First-Line Intervention for Patients With Hip or Knee Osteoarthritis or Both : Data From the BOA Register
- 2020
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 100:10, s. 1771-1781
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study explored the association of patients' demographics, health status, symptom severity, previous osteoarthritis (OA) care, and psychological status with the change in pain severity following a first-line intervention including education and exercise for OA provided nationwide in Swedish primary care. METHODS: This register-based cohort study included 23,309 people with knee or hip OA from the Better Management of Patients with OA register. Linear regression models were used to assess the association of independent variables with the change in pain from baseline to 3 and 12 months. All the analyses were stratified based on the affected joint (hip vs knee). RESULTS: In people with hip and people with knee OA, high levels of baseline pain were associated with decreased pain at both follow-ups (3 months: knee B = -.67; hip B = -.64; 12 months: knee B = -.70; hip B = -.66), whereas being older, overweight, or female had a weak or no association. Finally, at both follow-ups, bilateral OA was associated with increased pain only in people with knee OA, whereas comorbidities and the willingness to undergo surgery were associated with increased pain regardless of the affected joint. CONCLUSIONS: Baseline pain showed the strongest association among the analyzed variables, whereas sex, age, and body mass index appear to be weakly associated with the pain change after a first-line intervention. Comorbidities and willingness to undergo surgery showed a potentially important association and may have a negative impact on the pain change following a first-line intervention. IMPACT: In people with hip or knee OA, age, sex, body mass index, and previous surgery are only weakly associated with the change in pain after a first-line intervention supporting the evidence recommending exercise and education as a foundation for all OA therapy. Having comorbidities and being willing to undergo surgery is associated with a worse outcome from a first-line intervention, including exercise and education. Individualized treatments addressing the disease perception and the specific comorbidity profile may improve the outcomes.
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| 10. |
- Dell'Isola, Andrea, et al.
(författare)
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Within-person change in patient-reported outcomes and their association with the wish to undergo joint surgery during a digital first-line intervention for osteoarthritis
- 2023
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Ingår i: Osteoarthritis and Cartilage. - 1063-4584 .- 1522-9653.
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To study the association between within-person changes in patient-reported outcomes (PROMs) and wish for joint surgery during participation in a digital first-line intervention comprising exercise and education for knee/hip osteoarthritis (OA).Methods: Retrospective observational registry study. Participants enrolled between 01/06/2018 and 30/10/2021 with follow-up data at 3 months (n=13,961). We used asymmetric fixed effect (conditional) logistic regressions to study the association between change in wish to undergo surgery at last available time point (3,6,9 or 12 months) and improvement or worsening of PROMs pain (0-10), quality of life (EQ5D-5L, 0.243-0.976), overall health (0-10), activity impairment (0-10), walking difficulties (yes/no), fear of movement (yes/no) and Knee/Hip injury and Osteoarthritis Outcome Score 12 Items (KOOS-12/HOOS-12, 0-100) function and quality of life (QoL) subscales.Results: The proportion of participants wishing to undergo surgery declined by 2% (95% CI 1.9, 3.0), from 15.7% at the baseline to 13.3% at 3 months. Generally, improvements in PROMs were associated with reduced likelihood of wishing for surgery while worsening was associated with increased likelihood. For pain, activity impairment EQ-5D and KOOS/HOOS QoL, a worsening led to a change in the probability of wish for surgery of larger absolute magnitude than an improvement in the same PROM.Conclusions: Within-person improvements in PROMs are associated with reduced wish for surgery, while worsenings with an increased wish for surgery. Larger improvements in PROMs may be needed to match the magnitude of the change in wish for surgery associated with a worsening in the same PROM.
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