Allen Kelli D, Yancy William S, Bosworth Hayden B, Coffman Cynthia J, Jeffreys Amy S, Datta Santanu K, McDuffie Jennifer, Strauss Jennifer L, Oddone Eugene Z
Ann Intern Med. 2016 Jan 19;164(2):73-83. doi: 10.7326/M15-0378. Epub 2015 Dec 22.
Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused.
To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes.
Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740).
Department of Veterans Affairs Medical Center in Durham, North Carolina.
30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis.
The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record.
The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes.
At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ.
The study was conducted in a single Veterans Affairs medical center.
The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.
Department of Veterans Affairs, Health Services Research and Development Service.
骨关节炎的管理需要医学和行为策略，但一些推荐疗法未得到充分应用。
探讨患者与医疗服务提供者联合干预对改善骨关节炎结局的有效性。
整群随机临床试验，分为骨关节炎干预组和常规治疗组。（ClinicalTrials.gov：NCT01130740）。
北卡罗来纳州达勒姆的退伍军人事务部医疗中心。
30名医疗服务提供者（整群）和300名有症状的髋或膝骨关节炎门诊患者。
基于电话的患者干预侧重于体重管理、体育活动和认知行为疼痛管理。医疗服务提供者干预包括通过电子病历向初级保健提供者提供针对患者的骨关节炎治疗建议。
主要结局是12个月时西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分。次要结局是WOMAC功能和疼痛子量表评分、身体性能（简短身体性能量表）和抑郁症状（患者健康问卷-8）。采用针对医疗服务提供者聚类进行调整的线性混合模型评估组间结局改善的差异。
12个月时，骨关节炎干预组的WOMAC评分比常规治疗组低4.1分（表明有所改善）（95%CI，-7.2至-1.1分；P = 0.009）。干预组的WOMAC功能子量表评分低3.3分（CI，-5.7至-1.0分；P = 0.005）。WOMAC疼痛子量表评分（P = 0.126）、身体性能和抑郁症状在两组之间无差异。虽然骨关节炎干预组中更多患者因推荐的骨关节炎治疗而接受医疗服务提供者转诊，但接受转诊的人数并无差异。
该研究在单一退伍军人事务医疗中心进行。
患者与医疗服务提供者联合干预使髋和膝骨关节炎患者自我报告的身体功能有适度改善。
退伍军人事务部卫生服务研究与发展局。
