Patient and Provider Education Fails to Improve Osteoarthritis Outcomes Save

A randomized trial of 537 knee osteoarthritis (OA) patients in the Duke Healthcare system has shown that patient- and provider interventions were no better than the usual standard of care.

Specifically, they compared a program of telephone-based patient intervention (weight management, physical activity, and cognitive behavioral pain management) to provider intervention (electronic delivery of patient-specific osteoarthritis treatment recommendations to providers who treat knee OA).

No intervention, whether patient-based, provider-based, or a combination of the two, provided improvements over usual care for patients with knee osteoarthritis. These findings contradict conclusions from an earlier study suggesting that a combined intervention provided modest improvements in function and activity compared with usual care. These results are published in Annals of Internal Medicine.

Managing pain and function associated with hip or knee osteoarthritis requires both medical and behavioral strategies, but recommended therapies are underused. A single-site study conducted in a Department of Veterans Affairs medical center showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.

To examine whether patient-based, provider-based, and patient–provider interventions improve osteoarthritis outcomes, researchers randomly assigned 537 outpatients with symptomatic hip or knee OA treated in community-based primary care clinics to receive care using one of the three interventions - patient intervention, provider intervention or a combination of both approaches.

At 12 months, there were no significant improvements in WOMAC score for any of the intervention groups compared with usual care.

The authors note that the intervention was low-intensity. The authors suggest that higher-intensity interventions are needed to make more meaningful improvements in outcomes.