medwireNews: The PARTNER model of primary care delivery for patients with knee osteoarthritis (OA) may improve knee pain and function over that achieved by general practitioner (GP) care alone, say Australian researchers.
David Hunter (Royal North Shore Hospital, Sydney, New South Wales) explain that their telehealth model was designed to overcome barriers to health service access, such as distance, inconvenience, and the COVID-19 pandemic.
As reported in Arthritis Care & Research, the randomized controlled study focused on patients aged 45 years or older, who were registered with 38 practices in New South Wales and Victoria, and had self-reported activity-related knee pain at least 3 months earlier.
The GP practices were randomly assigned to continue delivery of usual care for 105 patients for 12 months or to receive the PARTNER model intervention, beginning with online professional development including a training module, self-audit and feedback activities, and access to a study website with resources.
After meeting with the 112 patients in the intervention arm, the GPs prepared a chronic disease management plan and 101 patients (92% of those eligible) were referred to a care support team for physiotherapy and occupational therapy.
This care consisted of 18 weeks of fortnightly contacts focusing on weight management, leg muscle strengthening, and physical activity, as well as access to cognitive behavioral therapy for mood, sleep, and coping with pain.
This was then followed by a 6-month maintenance phase with monthly patient contacts, the researchers explain.
Overall, 927 telephone consultations occurred, at an average of nine per patient, lasting an average of 24 minutes in the intensive phase and 29 minutes in the maintenance phase.
The researchers note that the trial recruitment was halted before the planned accrual of 44 practices and 572 patients, and that only 11% of the practices installed the recommended desktop support system, limiting the ability to collect information on the OA management plans.
Nevertheless, the majority of the enrolled patients completed surveys at both the 6-month (89%) and 12-month (88%) timepoints.
After 12 months, participants in the intervention arm had a 0.8-point greater improvement in self-reported knee pain on a 10-point rating scale than those given usual care, and a 6.5-point greater gain in function on the 100-point KOOS Activities of Daily Living subscale.
Although the pain improvement did not reach the 1.8-point or greater threshold for the minimal clinical important difference (MCID), the 95% confidence interval for activities of daily living function “spanned” the MCID range, the researchers say.
The PARTNER group achieved greater weight loss at 6 months than the usual care group (–1.4 kg and –0.5 BMI unit difference) but this effect did not persist after 12 months, whereas the intervention was associated with a greater improvement in sleep at 12 but not 6 months. There were no between-group differences at either timepoint for health-related quality of life, depression or fatigue.
Nevertheless, there was greater improvement in knee OA overall and more satisfaction with symptoms and treatment in the PARTNER group than with usual care, the investigators say.
After 12 months there was no significant difference in the medical costs and prescriptions reported for the intervention and usual care groups, although PARTNER patients had greater prescription costs at 12 months.
“[O]ur findings suggest that the PARTNER model improved knee pain and function more than usual GP care, although as the trial was underpowered our findings around the magnitude of change lack precision and should be interpreted with caution,” conclude Hunter et al.
“Further rollout of the telehealth-delivered care support team component of the PARTNER model is promising, however strategies to better engage with GPs and to reach more communities requires further work to ensure delivery of best-practice OA care nationally.”
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