Treatment of Knee Osteoarthritis in Primary Care: Needs, Influencing Factors, Outcome Prediction, and Implementation of Guidelines

Linda Baumbach

Research output: ThesisPh.D. thesis

Abstract

Introduction: Knee osteoarthritis (OA) is a common disease with increasing prevalence and burden for the population. Clinical guidelines recommend patient education, exercise, and weight reduction as first-line treatments, but they remain underutilized in many Western countries.
Methods: To improve the usage of the recommended first-line treatments, four measures were applied. First, the receipt of first-line treatment in the form of lifestyle advice given by the general practitioner (GP) in Denmark was evaluated in patients with knee OA and compared with that given for hypertension and diabetes (alone and in any combination). Second, algorithms predicting individualized outcomes of patient education and exercise were developed and validated to support shared decision-making during GP consultations. Third, the perceived professional barrier of GPs being concerned about harming the relationship they have with their patients when providing lifestyle advice was quantified by evaluating the association between received treatment elements and patient satisfaction. Fourth, internationally successful and tested interventions to improve the management of patients with knee OA at GP clinics were culturally adopted and implemented in one Danish GP clinic to study the sustainable effectiveness of these interventions.
Results: In Denmark, less than half the patients with knee OA received lifestyle advice. They were least likely to receive this advice when compared with patients suffering from hypertension or diabetes. Individualised outcome predictions were better than average estimations, but the improvements were not clinically relevant. The receipt of information on first-line treatments was positively associated with the patients’ satisfaction with their knee-related care. Lastly, the culturally adopted intervention to improve the quality of care for patients with knee OA at a GP clinic in Denmark had only a six-month lasting effect.
Conclusions: There is room for improving the quality of care given to patients with knee OA by GPs in Denmark by following the clinical guidelines of recommended first-line treatments. This may be achieved by assuring GPs that the average improvements in patient education and exercise may be used to motivate patients to adopt lifestyle changes. They may also be assured that patients’ satisfaction increases with the receipt of lifestyle advice. Lastly, future implementation studies using culturally adopted interventions, should take into account potential specific barriers of the individual clinics - including those in the professional and external context - to reach robust conclusions regarding their ability to support sustainable improvements.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Roos, Ewa Maria, Supervisor
  • Lykkegaard, Jesper, Supervisor
Date of defence18. Dec 2020
Publisher
Publication statusPublished - 18. Dec 2020

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