Optimizing osteoarthritis care through clinical and community partnership: Results of an exploratory trial.

BACKGROUND/PURPOSE: To conduct an exploratory trial of a clinic-community care model (OA CARE) for managing osteoarthritis (OA). DESIGN: Participants (n ​= ​60) with symptomatic knee or hip OA and overweight/obesity were randomized to OA CARE or a usual care control group (UC). Participants in the OA CARE group received a 12-month medical membership to a local YMCA, which included a 12-week weight loss program and access to exercise programming, as well as referrals to rehabilitation, nutrition, sleep-related and psychological services. Participants' primary care clinicians were given a video-based summary of OA treatment guidelines. Feasibility metrics included engagement with the weight loss program and exercise resources. Outcomes were assessed at baseline, 6-months and 12-months. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcomes were analyzed between groups across time points using general linear mixed models. RESULTS: Eighty-seven percent of the OA CARE group participated in the weight loss program, with a mean attendance of 9.2 sessions; 57 ​% participated in an exercise class. At 6-months, there was a statistically significant between-group difference in change in WOMAC total scores, with the OA CARE group showing greater improvement (-11.0, 95 ​% Confidence Interval -20.1, -1.9). At 12-months, the between-group change in WOMAC score was not statistically significant, though there was a small difference in favor of OA CARE Group (-4.9, 95 ​% Confidence Interval -14.1, 4.3). CONCLUSION: Feasibility metrics were positive, but effects of OA CARE were modest, and a more intensive approach may be needed to enhance impacts.

Duke Scholars

Author Kelli Dominick Allen Medicine, General Internal Medicine