This week the main results of a large NIH-funded trial on primary care-based interventions for osteoarthritis (OA), led by multiple GIM investigators, was published in Annals of Internal Medicine. Those authors are Drs. Kelli Allen, Eugene Oddone, Hayden Bosworth, Ranee Chatterjee, William Yancy, Santanu Datta, and Rowena Dolor.
Research involved 10 primary care clinics
The study was an ambitious cluster randomized trial that involved participation of 10 clinics within the Duke Primary Care Research Consortium. Study participants received either a telephone-based patient intervention (focusing on physical activity and weight management), a provider-based intervention (involving OA treatment recommendations delivered to primary care providers), both patient and provider interventions, or no intervention (usual care).
Results showed no differences
Overall study results showed that there were no significant differences among the four study groups at follow-up. Interestingly, however, all four groups (including usual care) showed clinically relevant improvement in OA symptoms over the course of the study. The clinically important improvement in the control group made it much harder to detect differences in the other three active treatment groups.
But compared to a parallel VA study
These results are in contrast to a parallel VA study, in which the same combined patient + provider intervention resulted in clinically relevant improvement when compared with a usual care (PMID:26720751) . In that study, the usual care control group did not improve over time. Also of note, the usual care group in the new Duke study had less severe OA symptoms at baseline than the other group in that study; this may have been an overall healthier group of patients who responded well to typical OA treatments delivered in the context of usual care.
More to learn
Taken together, results of the Duke and VA studies suggest that these OA-focused interventions may have differential benefit for different patients and in different health care systems. One possibility is that patients with more severe symptoms at baseline show greater benefit, and this question will be explored by the study team in future analyses of both studies.
Dr. Allen has spent much of her distinguished career advancing the health of patients with osteoarthritis by employing methods in health services, clinical and comparative effectiveness, and patient centered outcomes research. Her work has focused on improving care for OA, with a focus on self-management, physical activity, and physical therapy related care.
Kelli D. Allen, PhD; Eugene Z. Oddone, MD, MHSc; Cynthia J. Coffman, PhD; Amy S. Jeffreys, MStat; Hayden B. Bosworth, PhD; Ranee Chatterjee, MD, MPH; Jennifer McDuffie, PhD; Jennifer L. Strauss; William S. Yancy Jr., MD, MHS; Santanu K. Datta, PhD MHS; Leonor Corsino, MD, MHS; and Rowena J. Dolor, MD, MHS. "Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial." Annals of Internal Medicine (January 17, 2017). [Link]