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Jönsson T1, Dahlberg L2, Eek F3, Ekvall Hansson E4
1Lund University, Orthopedic, Clinical Science Lund, Lund, Sweden, 2Lund University, Department of Clinical Sciences, Lund, Sweden, 3Lund University, Department of Health Sciences, Division of Physiotherapy, Lund, Sweden, 4Lunds University, Department of Health Sciences, Division of Physiotherapy, Lund, Sweden
Background: Osteoarthritis (OA) in the knee or hip is ranked as the eleventh highest contributor to global disability. It is a chronic disease leading to substantial societal costs as well as personal suffering, such as pain and decreased physical function. According to guidelines, the primary treatment of OA is exercise, information regarding the disease and weight control. This core treatment should be offered as early as possible in the course of the disease to limit worsening of symptoms, and thereby potentially delay, or even evade, the need for surgery. Exercise has been shown to be an effective non-surgical intervention to counter OA-related symptoms. Pain reduction is especially important in OA management and studies about the outcome of education and exercise programs, such as the Swedish Better management of patients with Osteoarthritis (BOA) program is therefore of great interest.
Purpose: The purpose of this study was to evaluate the outcomes of the BOA intervention on pain intensity, pain frequency and the number of patients on painkillers.
Methods: Data from 62,016 individuals with OA who underwent the BOA program between 2008 and 2016, were collected from the BOA register, a Swedish National Quality Register. BOA comprises education and individually supervised exercise delivered by trained physiotherapists. In the register, patient-reported outcomes regarding pain intensity (Numeric Rating Scale, NRS, 0-10) and pain frequency (less than every month/every week or more often) at baseline, after 3 months and after 12 month are recorded. Furthermore, the physiotherapist completes a questionnaire at baseline and after 3 months concerning intake of painkillers (yes/no). The generalized linear model repeated measurement ANOVA adjusted for sex, age, BMI, joint and baseline value for NRS pain was used to calculate the difference between baseline and 3 month follow-up and baseline and the 12 month follow-up. McNemar's test was used to calculate the difference between baseline and follow-ups in pain frequency and number of patients on painkillers.
Results: Data from 37,795 individuals with OA, 68% women, from the BOA register were utilised in the analyses. It demonstrated that pain intensity significantly decreased for patients with knee or hip OA, from 5.3 (±1.9) to 4.2 (±2.2) (p 0,001), between baseline to 3 month follow-up and 5.2 (±1.9) to 4.4 (±2.4) (p 0,001), between baseline and 12 month follow-up. Significantly fewer individuals reported pain more often than every week at 3 month follow-up (n= 6,796) and at 12 month follow-up (n=7,821) compared to baseline. Finally, significant fewer individuals took painkillers (n=6,873) at 3 month follow-up.
Conclusion(s): Participation in BOA, a Swedish education and individually adapted exercise program for patients with OA, resulted in decreased pain intensity, decreased pain frequency and fewer individuals taking painkillers. In the future we need to evaluate which part of the BOA program that contributes to pain reduction.
Implications: The BOA program is implemented across all regions in Sweden. The results from this study will be used to improve the BOA program thereby resulting in a direct benefit for future participants in the BOA program. In addition, the level of evidence for the program has strengthened considerably.
Keywords: Ostearthritis, Education, Exercise
Funding acknowledgements: Lund University
Purpose: The purpose of this study was to evaluate the outcomes of the BOA intervention on pain intensity, pain frequency and the number of patients on painkillers.
Methods: Data from 62,016 individuals with OA who underwent the BOA program between 2008 and 2016, were collected from the BOA register, a Swedish National Quality Register. BOA comprises education and individually supervised exercise delivered by trained physiotherapists. In the register, patient-reported outcomes regarding pain intensity (Numeric Rating Scale, NRS, 0-10) and pain frequency (less than every month/every week or more often) at baseline, after 3 months and after 12 month are recorded. Furthermore, the physiotherapist completes a questionnaire at baseline and after 3 months concerning intake of painkillers (yes/no). The generalized linear model repeated measurement ANOVA adjusted for sex, age, BMI, joint and baseline value for NRS pain was used to calculate the difference between baseline and 3 month follow-up and baseline and the 12 month follow-up. McNemar's test was used to calculate the difference between baseline and follow-ups in pain frequency and number of patients on painkillers.
Results: Data from 37,795 individuals with OA, 68% women, from the BOA register were utilised in the analyses. It demonstrated that pain intensity significantly decreased for patients with knee or hip OA, from 5.3 (±1.9) to 4.2 (±2.2) (p 0,001), between baseline to 3 month follow-up and 5.2 (±1.9) to 4.4 (±2.4) (p 0,001), between baseline and 12 month follow-up. Significantly fewer individuals reported pain more often than every week at 3 month follow-up (n= 6,796) and at 12 month follow-up (n=7,821) compared to baseline. Finally, significant fewer individuals took painkillers (n=6,873) at 3 month follow-up.
Conclusion(s): Participation in BOA, a Swedish education and individually adapted exercise program for patients with OA, resulted in decreased pain intensity, decreased pain frequency and fewer individuals taking painkillers. In the future we need to evaluate which part of the BOA program that contributes to pain reduction.
Implications: The BOA program is implemented across all regions in Sweden. The results from this study will be used to improve the BOA program thereby resulting in a direct benefit for future participants in the BOA program. In addition, the level of evidence for the program has strengthened considerably.
Keywords: Ostearthritis, Education, Exercise
Funding acknowledgements: Lund University
Topic: Musculoskeletal; Health promotion & wellbeing/healthy ageing; Education: clinical
Ethics approval required: Yes
Institution: Lund University
Ethics committee: Regional Ethical Review Board in Gothenburg
Ethics number: 1059-16
All authors, affiliations and abstracts have been published as submitted.
