C. Allyson Jones1,2 , Geneviève Jessiman-Perreault1 , Ania (Anna) Kania-Richmond1,3 , Amy Metcalfe 3,4 , David A. Hart1,5, Lauren A. Beaupre1,2 , on behalf of the Bone and Joint Health SCN
1 Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
2 Dept of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
3 Dept of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
4 Dept of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
5 Dept of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Osteoarthritis (OA) is a painful chronic condition affecting primarily weightbearing joints, such as the hip and knee, often leading to difficulties in daily life. The prevalence of OA has been increasing significantly over the past few decades and is expected to rise due to factors like an aging population and increasing rates of obesity. While guidelines recommend exercise and education as the first-line treatment for OA, many healthcare providers do not suggest these approaches. The Good Life with osteoArthritis: Denmark (GLA:D™) program was developed to address this gap in evidence and clinical practice by delivering education and neuromuscular exercises for individuals with hip and knee OA. It has been implemented in several countries, including Canada, with positive results. Earlier work has shown that the GLA:D™ program is effective in reducing pain and improving quality of life for people with OA. Most of these studies, however, focused on participants in large urban regions who use private payment models, disregarding the effectiveness in different settings and healthcare systems.
The primary issue we address in this project is the effectiveness of the GLA:D™ program for OA symptoms in diverse settings within the province of Alberta, Canada. Recognizing issues of access across the urban-rural divide and with limited publicly funded programming, we sought to understand whether this program delivers consistent outcomes across geographic locations (i.e., metro, metro-influenced, urban, or rural), with different types of payors: privately or covered by the public healthcare system. Our study’s primary finding is that the GLA:D™ program is an effective intervention for improving the quality of life and functional capabilities of patients with OA, irrespective of geographic location or payment method. Though we observed differences in pain relief between privately paid and publicly funded program, these differences were likely a chance finding due to multiple testing.
This cohort study used de-identified PROMs data made available from the GLA:D™ Canada Outcomes Database, collected from initial program implementation (September 2017) to March 2020. Data were collected through questionnaires and physician reported outcomes completed by participants at the beginning and end (i.e., after 3-months) of the program. The questionnaires collected information on demographics, pain (HOOS/KOOS), joint related quality of life (HOOS/KOOS), and health related quality of life (EQ-5D-5L). Physicians reported results from two functional tests (30-second chair stand and 40-metre walk test).
The study included 974 participants who were mostly female (76.6%) with knee OA (69.4%) and analyzed differences in clinically important improvements in outcomes based on program location and payor. Almost half of the participants attended the program in metro areas (47.3%), and the majority paid privately for it (61.5%). Overall, the GLA:D™ program led to individuals experiencing clinically important improvements in pain (13.3%), joint-related quality of life (25.5%), and health related quality of life (26.6%) at the 3-month follow-up. Functional tests (30-second chair stand and 40-metre walk test) also showed improvements (72.1% and 76.4%, respectively). The study found no statistical differences in program effectiveness based on program location or payor, except for pain. Participants in publicly funded primary care centers reported greater improvements in joint-related pain compared to those in private clinics (p=0.03), but this finding may be spurious. A limitation of this study is that we do not have information on those who qualify for the GLA:D™ program but did not choose to participate. Future research should delve deeper into the factors that influence patient participation, with a particular focus on accessibility (economic and geographic) to the GLA:D™ program.
This study suggests that the GLA:D™ program is effective in improving pain, quality of life and functional movement for individuals with OA, regardless of program location or payor. These findings contribute to the growing support of the program’s feasibility and effectiveness within the Canadian healthcare system. These findings also provide valuable insights for implementing the program in diverse healthcare settings, which can ultimately improve access to OA care.
For more information on the project and to view our resources, read the journal article here.
Abstract will be presented in Friday Poster Session II on Friday, 20 October, 2:55 pm – 3:35 pm.
This newsletter editorial represents the views of the author and does not necessarily reflect the views of ISOQOL.
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