medwireNews: Implementation of an evidence-based structured care model among general practitioners (GPs) and physiotherapists may lead to improved quality of care for patients with osteoarthritis (OA), indicate findings from a cluster randomized controlled trial.
Nina Østerås (Diakonhjemmet Hospital, Oslo, Norway) and colleagues explain that “[a]n evidence-to-practice gap for OA care has been identified internationally, with poor uptake of non-pharmacological approaches such as patient education and exercise treatment in contrast to surgical treatment.”
To address this, they created the SAMBA model with the intention of improving “the quality of OA care through delivery of evidence-based recommendations for OA care, focusing on the core treatments, first-line analgesics, and facilitating multidisciplinary collaboration.”
They tested the structured care pathway of the model among 40 GPs and 37 physiotherapists from six different regions in Norway, all of whom attended interactive workshops with an update on OA treatment recommendations.
The model itself included a GP consultation, an 8- to 12-week physiotherapist-led OA education and exercise program, an optional healthy eating program, and a GP review consultation. The GPs were trained to explain the OA diagnosis and treatment options, provide pharmacologic treatment when necessary, and suggest referral to physiotherapy.
During the control phase, when care providers were naïve to the SAMBA model, 109 patients with symptomatic hip or knee OA were recruited to the study and received usual care. At baseline, they completed the OsteoArthritis Quality Indicator version 2 questionnaire and recorded an average pass rate of 37%, indicating that they answered yes to 37% of the 16 questions about the receipt of appropriate care. At 6 months the pass rate was 41%.
By comparison, the 284 patients recruited during the intervention period who were treated according to the SAMBA model recorded a 39% pass rate at baseline which increased to 60% at 6 months, with the improvement mainly due to increased reports of patient education about the disease and treatment alternatives, self-management, and exercise.
However, the researchers note that the mean difference of 18.9% between the two groups, although statistically significant, did not quite reach the prespecified cutoff of 20.4% to indicate a minimally important change.
Among the secondary outcomes assessed, Østerås and team found that individuals treated under the SAMBA model were significantly more likely to be satisfied with OA care, fulfill physical activity recommendations at 6 months, and to have been referred to physiotherapy by 3 months than those treated during the control period, at odds ratios (ORs) of 12.1, 9.3, and 2.5, respectively.
Patients in the intervention group were also significantly less likely than those in the control group to have been referred to an orthopedic surgeon at 6 months (OR=0.3) but there was no significant difference between the two groups in the proportions referred for magnetic resonance imaging or who were overweight or obese.
Writing in PLOS Medicine, Østerås and co-authors conclude: “When GPs and [physiotherapists] are guided in the steps of structured, evidence-based care models, people with hip or knee OA may receive care that is more in line with current recommendations for OA care.”
They add: “By scrutinising the individual [Quality Indicator] item pass rates, ideas for further improvements of the care model may be generated, e.g., regarding advice and support on weight reduction.”
By Laura Cowen
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