Background
Methods
Searches
Eligibility criteria
Inclusions | |
Population | Adults aged 18 years and over with OA. The study population must have OA in multiple joint sites (at least two sites from the hand, hip, knee or foot). |
Intervention | Multidisciplinary interventions that target the NICE7 core treatments in primary care (“multidisciplinary” is defined as involving at least two different health disciplines). |
Comparison | Usual care, uni-disciplinary approaches, placebo interventions or no intervention. |
Outcome | Primary outcomes of interest were self-reported pain, function, QoL and health care utilisation. |
Design | The study population must form part of an RCT. |
Exclusions | |
Population | Inflammatory arthritis; surgical interventions, specified peripheral joint pain conditions, chronic widespread pain (CWP). |
Intervention | Non-randomised controlled trials. Studies not published in the English language. |
Comparison | Surgical interventions. |
Outcome | No measure of any of the key outcomes listed in the inclusion criteria |
Design | Single discipline approaches |
Selection of eligible studies
Data extraction
Quality assessment/Risk of bias
Hopman-Rock & Westhoff (2000) [16] | van Baar et al. (2001) [19] | Rosemann et al. (2007) [18] | Hansson et al. (2010) [17] | |
---|---|---|---|---|
Sequence generation | ? | + | + | ? |
Allocation concealment | ? | + | + | + |
Blinding | ? | ? | ? | ? |
Incomplete outcome data | ? | + | ? | + |
Selective outcome reporting | ? | ? | ? | + |
Other sources of bias | ? | ? | ? | ? |
Hopman-Rock & Westhoff (2000) [16] | van Baar et al. (2001) [19] | Rosemann et al. (2007) [18] | Hansson et al. (2010) [17] | |
---|---|---|---|---|
1. Eligibility criteria were specified | (1) | (1) | (1) | (1) |
2. Subjects were randomly allocated to groups | 1 | 1 | 1 | 1 |
3. Allocation was concealed | 0 | 1 | 0 | 1 |
4. The groups were similar at baseline regarding the most important prognostic indicators | 1 | 1 | 1 | 1 |
5. There was blinding of all subjects | 0 | 0 | 0 | 0 |
6. There was blinding of all therapists who administered the therapy | 0 | 0 | 0 | 0 |
7. There was blinding of all assessors who measured at least one outcome | 0 | 0 | 1 | 0 |
8. Measures of at least one key outcome were obtained from more than 85 % of the subjects initially allocated to groups | 1 | 1 | 0 | 1 |
9. All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by ‘intention to treat’ | 1 | 1 | 1 | 1 |
10. The results of between-group statistical comparisons are reported for at least one key outcome | 1 | 1 | 1 | 1 |
11. The study provides both point measures and measures of variability for at least one key outcome | 1 | 1 | 1 | 1 |
12. Pedro Score | 6 | 7 | 6 | 7 |
Results
Studies & trial design | Sample size | Setting | Health disciplines | OA sites | Mean age of participants (SD) | Primary outcomes within studies | Secondary outcomes within studies | Key findings of studies |
---|---|---|---|---|---|---|---|---|
Hopman-Rock & Westhoff (2000) [16] RCT | N = 105 Intervention = 56 Control = 49 | Single Centre (Netherlands) Primary Care | Physiotherapy, Occupational Therapy (OT) and General Practitioner | Hip or Knee | Intervention =65.4 (5.3) Control =65.2 (5.7) | IRGL self-reported pain. Pain severity (VAS) | QoL (VAS) QoL seven question sum score Activity restriction, ROM Muscle strength Observed activity restrictions Healthcare utilisation, lifestyle behaviour, BMI | Significant MANOVA effects were found for pain, QoL, quadriceps, BMI, physically active lifestyle, and visits to the physical therapist. Most effects were moderate at post-test assessment and smaller at follow-up. No effects were found for range of ROM or functional tasks |
van Baar et al. (2001) [19] Single blind RCT | N = 201 Intervention = 99 Control = 102 | Multi-Centre (Netherlands) Primary Care | General Practitioner and Physiotherapy | Hip or Knee | Intervention 68.3 (8.4) Control =67.7 (9.2) | IRGL self-reported disability, VAS pain in the past week | Observed disability, Drug use NSAIDs/paracetamol, Global perceived effect, muscle strength & ROM hip, knee, physical activity | At 24 weeks exercise treatment was associated with a small to moderate effect on pain during the past week (difference in change between the two groups −11.5 (95 % CI −19.7 to −3.3). At 36 weeks no differences were found between groups. |
Rosemann et al. (2007) [18] 3-arm pragmatic cluster trial | N = 1021 Intervention 1 =345 Intervention 2 =344 Control = 332 | Multi-Centre (Germany) Primary Care | General Practitioner and Practice nurse | Hip or Knee | Intervention 1 = 65.59 (14.68) Intervention 2 = 66.27 (15.19) Control =66.11 (15.02) | AIMS2-SF QoL, lower body, upper body, symptom & social. | IPAQ physical activity, BMI, prescriptions. Health service utilisation | Compared with the control group, for intervention group II, significant changes in the AIMS2-SF dimensions social (p < 0.001), symptom (p = 0.048), and lower body (p = 0.049) were identified. Radiographs (P = 0.031) and orthopaedic referrals (p = 0.044) decreased whereas prescriptions of pain relievers increased significantly. |
Hansson et al. (2010) [17] Single blind RCT | N = 114 Intervention = 61 Control = 53 | Single Centre (Sweden) Primary Care | Physiotherapy, OT, Orthopaedic Specialist, Nurse, Nutritionist | Knee, Hip or Hand | Intervention =62 (9.43) Control =63 (9.51) | EQ5D index and EQ5D VAS | ASES pain, function & other symptoms. GAT, SOLEO, SOLEC, One legged jump/raising, OA location & BMI | Significant differences between the intervention group and the control group, comparing the results at baseline and after 6 months in EuroQol-5D (p < 0.001) and in SOLEC (p = 0.02) in favour of the intervention group. |
Studies | Intervention(s) | Control | |
---|---|---|---|
Hopman-Rock & Westhoff (2000) [16] | Six weekly sessions lasting 2 h. First hour: Peer educator advice on Pathophysiology of OA, lifestyle and physical activity, pain management, weight reduction and diet, ergonomic and medical aspects of OA; treatments and x-rays. Questions answered by a visiting GP and OT. Second Hour: Physiotherapy lead exercise program. Education on rest and activity and the benefits of walking. Warming up exercises and relaxation exercises specific to knee and hip. Fifteen minutes of each session was spent on education about the balance between rest and activity and the types of activity. The course included the use of a pain diary and personal goal planning. | Unclear - states without intervention | |
van Baar et al. (2001) [19] | The patients were given exercise treatment individually by a physiotherapist in primary care (1–3 sessions per week). In addition, their GP provided patient education (including a brochure) and medication management, if necessary. One exercise protocol was used for both the hip and knee patients. It included exercises for muscle function, mobility and coordination. Instructions were also given for adaptation of the activities of daily living and home exercises. | Treatment was restricted to that given by their GP in the intervention, (patient education and medication management, if necessary). | |
Rosemann et al. (2007) [18] | Intervention 1: GPs received two interactive peer group meetings (8 h each) that focussed on evidence based treatment of OA in primary care (including a written summary of guidelines), arthritis self-management programs and motivational skills for working with patients. GPs were given patient education leaflets including a physical exercise programme in a booklet and on audio CD. Intervention 2: GPs received the same as Intervention 1. in addition a practice nurse was trained to monitor participants via a monthly telephone call; and to check adherence to GP prescriptions and advice and to ask about increasing pain and possible side effects of medication | Usual care | |
Hansson et al. (2010) [17] | The patient education programme for osteoarthritis (PEPOA). The programme lasted for 5 weeks, with group sessions once a week, 3 h for each session. | Described as ‘living as usual’ | |
First session | A physiotherapist and occupational therapist provided information about anatomy and physiology of pain and coping with pain. Brainstorming was used to discover what the participants found hard to do. | ||
Second session | A physiotherapist provided information about exercise and physical activity and gave a practical demonstration of home-training exercises for the lower extremity. A demonstration of different kinds of orthopaedic aids for the lower extremity was also given. | ||
Third session | An orthopaedic specialist, nurse and nutritionist provided information about OA and current research. Information about medications and appropriate diet were also given. | ||
Fourth session | An OT provided ergonomics and practical instructions about equipment and technical aids. Feedback to the brainstorming session from session one was provided. | ||
Fifth session | An OT provided information about surgery of the hand, and demonstrated the use of orthopaedic aids for hands. A practical demonstration of home training exercises for the hand was provided. |
Pain
Function
Quality of life
Health economics evaluation
Studies | Pain | Function | Quality of Life (QoL) | Health care utilisation |
---|---|---|---|---|
Hopman-Rock & Westhoff (2000) [16] | The IRGL pain subscale indicated that the experimental group reported fewer pain symptoms at the post-test assessment than the control group. Pain (VAS) showed a positive effect of the intervention on the experimental group | There was no improvement in IRGL mobility. No significant differences were found for extension, flexion, exorotation or endorotation of the hips and knees. The strength of knee extensors improved in both legs in post-test assessment. MANOVA showed a statistically significant improvement in strength of left knee extensor. No statistically significant improvements were seen in the functional tasks of walking, timed up-and-go, stair climbing and toe reaching as both groups improved. | Whilst QoL (VAS) remained stable at the post-test assessment in the experimental group, it had decreased in the control group. At F/U this was no longer found. | No statistically significant differences were found in the use of medication or on the number of GP consultations. Physical therapy consultations were reduced |
van Baar et al. (2001) [19] | At 24 weeks (12 weeks after completion of treatment), a beneficial effect was seen for pain during the past week. Compared with the post-treatment level (week 12) the effect size had declined to 0.36, indicating a small to moderate effect. | At 24 weeks no effects were found for self-reported disability, muscle strength, and range of motion. Similar effects were found at week 36. | _ | There was a reduction in the use of paracetamol at 24 weeks that remained stable at 36 weeks F/U |
Rosemann et al. (2007) [18] | Statistically significant improvements were seen for the ‘Symptom’ component of the AIMS2-SF in intervention group 2. | No statistically significant improvements in IPAQ sores | Statistically significant improvements were shown for the lower body, symptom and social components of the AIMS2-SF | There was a statistically significant reduction in orthopaedic referrals in intervention group 2 and x-rays in intervention groups 1 & 2 |
Hansson et al. (2010) [17] | No improvements were shown for ASES pain scores. EQ-5D scores reduced in the experimental group. | There was no statistically significant improvement in ASES function, GAT or SOLEO but there was a statistically significant improvement on SOLEC | There was a statistically significant improvement in the EQ-5D VAS but not the EQ-5D index. | _ |