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  1. T. Moseng1,
  2. H. Solveig Dagfinrud1,
  3. B. Natvig2,
  4. N. Osteras1
  1. 1Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Oslo, Norway
  2. 2University of Oslo, Institute of Health and Society, Department of General Practice, Oslo, Norway


Background: To ensure delivery of high-quality osteoarthritis (OA) care, structured care models incorporating patient education and exercise are increasingly implemented in primary care 1. A goal is to improve patients’ physical function and coping with daily life demands and activities. Yet, there is limited knowledge regarding the type and severity of activity limitations experienced by people with hip and knee OA.

Objectives: 1) To map activity limitations reported by patients with hip and knee OA participating in a research study implementing an OA care model in primary care. 2) To investigate potential changes in self-reported difficulty performing these activities from baseline to 12-weeks follow-up.

Methods: A structured OA care model was implemented in six Norwegian municipalities between January 2015 and October 2017, using a stepped-wedge cluster-randomized controlled design. Implementation was facilitated by interactive workshops for general practitioners and physiotherapists (PTs). The PTs provided a 3-hour, group-based patient education program followed by individually tailored 8-12 weeks exercise with twice weekly 1-hour supervised group sessions. Patients with clinically or radiologically verified symptomatic hip or knee OA ≥45 years were eligible. Patients who received the new model of care completed the Patient-Specific Functional Scale (PSFS) at baseline by identifying between one and three “important activities that you are unable to do or are having difficulty with because of your hip or knee OA”. The patients rated their performance of the reported activities on an 11-point numeric rating scale (NRS) ranging from 0 (unable to perform activity) to 10 (perform activity with no problems). After 12 weeks the patients re-rated their previously identified activities. The reported activities were linked to the International Classification of Functioning, Disability and Health (ICF) at Chapter and Domain (second and third) level. Absolute change in scores from baseline to follow-up was calculated as the mean score of the reported activities. Change from baseline to follow-up was investigated using paired samples t-test. P-value was set to <0.05. Clinically important change was regarded 2 points on the 0-10 scale.

Results: A total of 284 patients received the new model of care. The mean age was 63 (SD 10) years, and 211 (74%) were female. The main affected OA joint was the knee for 174 (61%), the hip for 100 (35%) and other joints (e.g. hand) for 9 (3%). The PSFS was completed by 152 (53%) patients, of which 13 reported one, 42 reported two and 97 reported three activities. A total of 382 activities were linked with ICF. Of these, 362 (95%) were linked to the Activities and Participation chapter (D). On second-level, 318 (83%) activities were linked to the Mobility domain (D4). On the third-level, the majority of activities were linked to the domains Changing body positions (d410) (26%), Walking (d450) (23%) and Moving around (d455) (25%). The patients reported significantly less difficulty performing their self-reported activities at 12 week follow-up (4.1 (SD 1.7) versus 6.3 (SD 1.8), mean change 2.1 (95% CI 1.8, 2.5), p<0.001).

Conclusion: The majority of activity limitations reported by patients receiving a structured OA care model in primary care were within the ICF Mobility domain. The most common third-level ICF domains were Changing body positions, Walking and Moving around. After participating in OA patient education and structured 8-12 weeks of exercise, the patients reported a statistically significant and clinically important improvement in the difficulty of performing their individual activities.

References: [1]Allen KD, Choong PF, Davis AM, et al. Osteoarthritis: Models for appropriate care across the disease continuum. Best practice & research. Clinical rheumatology. 2016;30(3):503-535.

Disclosure of Interests: None declared

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