| 1. |
- Dahlberg, Leif E., et al.
(författare)
-
Improving osteoarthritis care by digital means - Effects of a digital self-management program after 24- or 48-weeks of treatment
- 2020
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:3
-
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.
|
|
| 2. |
- Dell'Isola, Andrea, et al.
(författare)
-
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
-
Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 100:10, s. 1771-1781
-
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.
|
|
