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| Name | Class |
|---|---|
| University of Southern Denmark | OTHER |
| University of Oulu | OTHER |
| University of Helsinki | OTHER |
| Tampere University |
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This project aims to bridge the gap between guideline recommendations and clinical practice in osteoarthritis (OA) management. By implementing a systematic, evidence-based model of care, the project seeks to improve patient outcomes, reduce healthcare costs, and provide equitable access to care. The project consists of three phases. In the first phase the current OA care is mapped through registry review and questionnaires and interviews of patients and healthcare professionals. In the second, implementation phase of the project, a plan will be created how to support healthcare professionals in delivering care according to the new model of care and training and support will be offered according to the plan. In the third phase of the project, the implementation success will be evaluated, and the costs of OA care evaluated and compared to baseline data. In addition, patient-reported data will be collected from those patients, who participate in the group-based exercise and education program.
Osteoarthritis (OA) is a growing global health challenge, due to the significant increase in prevalence of knee and hip OA. In Finland, OA care costs are substantial, driven by diagnostic procedures, medical treatments, and indirect costs such as work absenteeism. The international guidelines recommend education, exercise, and weight management as first-line treatment options, but adherence to guidelines is inconsistent. This project aims to explore regional differences in OA care and beliefs and OA care practices in Finland. In addition, we will implement and evaluate a guideline-based model of care for hip and knee OA, that includes the Good Life with osteoarthritis from Denmark (GLA:D®) program as the preferred non-surgical management option in local care pathways. In addition, the aim is to share evidence-based OA knowledge and management skills nationwide.
This study is a hybrid type-3 benchmarking-controlled implementation trial. It is nested in primary healthcare in two Wellbeing Services Counties. The study includes three phases: pre-implementation, implementation, and evaluation. The pre-implementation activities include mapping the current OA care through registry review (healthcare utilization and costs from 2019-2024). In addition questionnaires and interviews of patients and healthcare professionals (beliefs and practices) will be conducted. Planned activities of the implementation phase include developing and integrating a new model of care (including GLA:D®) into local care pathways, and training physiotherapists to deliver it. Implementation theories and multifaceted implementation strategies will be used and adapted locally. The activities to evaluate the process include assessment of the implementation outcomes on healthcare professional and organizational levels, healthcare resource utilization and cost outcomes (1, 3 and 5 years) using registry data. In addition outcomes reported by patients participating in the GLA:D program will be collected at 3 months and 1, 3 and 10 years.
This project aims to bridge the gap between guideline-recommended OA-management and clinical practice. By implementing a systematic, evidence-based model of care, the study seeks to improve patient outcomes, reduce healthcare costs, and provide equitable access to care. The findings will inform future OA care strategies and will be disseminated and adapted to other healthcare contexts in Finland and can be adapted also internationally. The findings will be published in peer-reviewed journals and presented in national and international conferences.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients participating GLA:D program | |||
| GLA:D -trained physiotherapists |
| ||
| Registry data from national registries (pre) | Data of people with hip or knee OA from national registries from all Wellbeing Services Counties in Finland before the implementation of new model of care. | ||
| Registry data from national registries (post) | Data of people with hip or knee OA from national registries from all Wellbeing Services Counties in Finland after the implementation of new model of care. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Implementation of a guideline-based model of care for hip and knee osteoarthritis | Behavioral | Guideline-based model of care including GLA:D (Good Life with osteoArthritis from Denmark) -program that includes training for physiotherapists and group based education and exercise for patients with hip and knee OA. |
| Measure | Description | Time Frame |
|---|---|---|
| Cost of OA care | Healthcare cost associated with the new care pathway incluing annual healthcare consultation prevalence, number and cost of hospitalizations, OA-related surgical interventions and primary and specialized healthcare and outpatient specialist visits. Filled prescriptions, number and duration of OA-related sick leaves and disability pensions. Costs will be analysed using data from national registers in pre and post implementation, both within the pilot Wellbeing Services Counties and between the pilot and other Wellbeing Services Counties. | 1 (primary endpoint), 3 and 5 years after implementation compared to baseline 2018-2024 |
| Reach: Proportion of patients directed according to the model of care | Proportion of patients with hip and knee related symptoms and OA who contact healthcare that are referred to direct access physiotherapy and to GLA:D program | 1 (primary endpoint) 3 and 5 years after implementation |
| Measure | Description | Time Frame |
|---|---|---|
| Number of trained GLA:D trainers and physiotherapists | Number of trained GLA:D trainers and physiotherapists in Finland, recorded in GLA:D Finland database by PI. | 1, 3 and 5 years after implementation |
| Participation of patients in GLA:D program |
| Measure | Description | Time Frame |
|---|---|---|
| The Determinants of Implementation Behaviour Questionnaire | The multiprofessional version of Determinants of Implementation Behaviour Questionnaire (DIBQ-mp) Clinician reported determinants of implementation of guideline-based model of care and GLA:D program, designed according to the Theoretical Domains Framework. The items will be scored each separately on 7-point likert scale, where a lower score indicates that item being a barrier (worse outcome) and higher score towards facilitator (better outcome). |
Data from national registries:
Collection of GLA:D patient-reported outcomes:
Inclusion Criteria:
Exclusion Criteria:
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National registry data: Patients with diagnosed OA from all Wellbeing Services Counties in Finland
GLA:D patient-reported outcome data: Patients who are participating in the GLA:D program, diagnosed with hip or knee osteoarthritis in any location that delivers GLA:D program.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Riikka T Holopainen, PhD | Contact | +358401696566 | riikka.holopainen@movedoc.fi |
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| OTHER |
| University of Limerick | OTHER |
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Number of participants in GLA:D groups
| 1, 3 and 5 years after implementation |
| Pain intensity during last week, numerical rating scale | Numerical rating scale (NRS) 0-10, where 0 means no pain (better outcome) and 10 worst possible pain (worse outcome). a) worst pain b) average pain | Baseline, 3 months, 1, 3 and 10 years |
| Problems walking due to knee /hip | yes / no | Baseline, 3 months, 1, 3 and 10 years |
| UCLA activity score | UCLA activity score, 1= wholly inactive (worse outcome), 10 = regularly participate in impact sports (better outcome) | Baseline, 3 months, 1, 3 and 10 years |
| Fear of movement | Are you afraid that your joints will be damaged from physical activity and exercise? yes / no | Baseline, 3 months, 1, 3 and 10 years |
| Use of painkillers | Yes / no, and type of pain killers | Baseline, 3 months, 1, 3 and 10 years |
| Current employment | Employed / student / unemployed / on sick leave full time / on sick leave part time / early retirement due to low ability to work / self-imposed early retirement / retired | Baseline, 3 months, 1, 3 and 10 years |
| Sick leave because of knee / hip during last year | no / yes, under 1 month, yes 1-3 months, yes more than 3 months | Baseline, 3 months, 1, 3 and 10 years |
| EQ-5D-5L | Mobility (1-5), self-care (1-5), usual activities (1-5), pain/ discomfort (1-5), anxiety / depression (1-5), eq-vas (0-100). Lower scores indicate a worse outcome. | Baseline, 3 months, 1, 3 and 10 years |
| K/HOOS-12 | KOOS-12 asked if most affected joint is knee and HOOS-12 asked is most affected joint is hip. Scale 1-4 for each item, a lower score indicates a better outcome. | Baseline, 3 months, 1, 3 and 10 years |
| Global perceived effect | Much worse, an important worsening - much better an important improvement. 7-point likert scale, where a higher score indicates a better outcome. | 3 months, 1, 3 and 10 years |
| Satisfaction with GLA:D | 1-5 Not at all satisfied - very satisfied, higher score indicates a better outcome. | 3 and 12 months |
| How often do you use what you've learned in GLA:D? | Never (1), every month (2), every week (3), every day (4), several times a day (5), a higher score indicates a better outcome. | 3 months, 1, 3 and 10 years |
| Number of education and exercise sessions competed (face to face / online) | Numeral value | 3 months |
| Falls over the last year | Number of falls | Baseline, 3 months, 1, 3 and 10 years |
| Compliance in GLA:D program | Number of participated GLA:D sessions / participant. | 3 months |
| Numbers of sites training / implementing GLA:D -program | Number of sites training / implementing GLA:D -program in Finland. In numbers, based on documentation on GLA:D database by PI. | 1, 3 and 5 years after implementation |
| Number of GLA:D groups running | Number of active GLA:D groups running, numbers, based on documentation on GLA:D Finland database by PI. | 1, 3 and 5 years after implementation |
| Modifications in the Model of care | Descriptive qualitative reporting based on research diary: When and how modifactions in the Model of Care and Care pathways occured, whether it was unplanned or planned, reasons and goals for modification. | 1, 3 and 5 years after implementation |
| after delivering first GLA:D program and at 12 months |
| Gender | Male / female / other | Baseline |
| Age | in years | Baseline |
| Living situation | Living alone or with others | Baseline |
| Educational level | Basic and vocational education | Baseline |
| Medical comorbidities | High blood pressure and high cholesterol, Musculoskeletal conditions, Cardiovascular and blood diseases, Neurological diseases, Hormonal diseases, urinary diseasses, Gastrointestinal and liver diseases, Lung diseases, Cancer, Mental conditions, Diseases in the skin and other chronic diseases | Baseline |
| Smoking | Smoking status | Baseline |
| Duration of joint symptoms | Duration of joint symptoms in months / years | Baseline |
| Most affected joint | Most affected joint (right/left hip, right/left knee) | Baseline, 1, 3 and 10 years |
| Other affected joints | Other affected joints (right/left hip, right/left knee) | Baseline, 3 months, 1, 3 and 10 years |
| Previous injury knee /hip | Previous injury that cuaused the person consult a doctor | Baseline |
| Previous X-rays of affected joints | No / yes, more than 6 months ago / yes, within last 6 months / don't know | Baseline |
| Osteoarthritis checklist | Knee: load related pain, reduced functional capacity, morning stiffness, crepitus, reduced knee movement, bony enlargement, age, sex, overweight, previous joint injury, occupational / recreational overuse / family members with osteoarthritis Hip: hip pain, stiffness after inactivity, reduced functional capacity, reduced hip flexion, reduced internal hip rotation, painful internal hip rotation, age, sex, overweight, previous joint injury, occupational / recreational overuse / family members with osteoarthritis | Baseline |
| Previous and planned surgery of knee and hip | Type and time of surgery | Baseline (previous and planned surgery), 3 months, 1, 3 and 10 years (planned surgery) |
| Short form of Orebro musculoskeletal pain screening questionnaire | 0-100 points, higher score indicates a higher risk (<40 points = low risk, 40-50 points = medium risk, >50 points = high risk) | Baseline, 3 months, 1, 3 and 10 years |
| Expectations on GLA:D program | 1-5 1= very large / complete improvement, 5 = Very small or no improvement | Baseline |
| ID | Term |
|---|---|
| D015207 | Osteoarthritis, Hip |
| D010003 | Osteoarthritis |
| ID | Term |
|---|---|
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
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| ID | Term |
|---|---|
| D010208 | Papaverine |
| ID | Term |
|---|---|
| D044182 | Benzylisoquinolines |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D053610 | Opiate Alkaloids |
| D007546 | Isoquinolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
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