Information, exercise and weight reduction are recommended as first line treatment for patients with hip or knee osteoarthritis (OA) whereas only a minority of OA patients are eligible for surgical interventions. The guidelines are not reflected in clinical practice. OA cause high costs to society and the indirect costs are approximately five times as high as the direct costs forOA health care. A minority of OA patients receiving surgery have seen a physiotherapist at any time before surgery.
During 2008 a national programme was introduced in Sweden to standardize and improve care and management of patients with hip or knee OA; Better management of patients with OsteoArthritis (BOA www.boaregistret.se). The intervention is a supported osteoarthritis self-management programme for patients with hip or knee OA, including information on pathology, etiology, available treatments, and coping strategies. Furthermore, one of the three theoretical classes is held by an osteoarthritis communicator, i.e. a patient with OA who has been educated to teach about the lived experience with OA. Physiotherapists are educated over two days about the programme. Individually adapted exercises are optional. Patient-reported outcome measures (PROM), including EQ-5D, co morbidity, pain, physical activity, self-efficacy, work capacity, and satisfaction, are assessed at baseline, 3 and 12 months. Compliance to intervention is reported by the physiotherapist. These outcomes are registered in a national data base, the BOA register.
Results BOA became a Swedish National Quality registry in 2010. Nearly 17000 patients from 230 clinics are included. Each clinic can extract their results online and in real time.
About 1300 physiotherapists over Sweden have been educated to deliver and evaluate the BOA intervention in a standardized way. Data from 9 800 consecutive patients followed for three months, showed that 97% attended the theory sessions and 82% volunteered for the individual exercise programme. Of 4100 patients followed for 12 months 72% reported that they used what they had learned during the programme at least on a weekly basis. A study including 400 patients on waiting list for orthopaedic consultation, and who received the BOA intervention during waiting time, showed that 65% were satisfied after the intervention and declined to see the orthopaedic surgeon. Still one to three years after the intervention patients were satisfied without surgery.
Conclusions These results initiated a change in care routines in Sweden. Registering nationwide population-based information of OA patients and the results from intervention enables knowledge that can be used for continuous improvement and implementation of OA guidelines in clinical care, and to avoid non-evidence based treatments and diagnostics. By merging the BOA-register with other National Quality registries patients can be followed during the course of disease, and factors predicting prognosis and outcome of treatments like joint replacement surgery can be identified.
Disclosure of Interest None Declared