Factors Associated With the Outcome of a First-Line Intervention for Patients With Hip or Knee Osteoarthritis or Both: Data From the BOA Register.
Andrea Dell'Isola, Therese Jönsson, Håkan Nero and 2 others
PMID 32589713WHAT IT FOUND
More baseline pain was associated with larger pain reduction after a physical therapist-led education, self-management and personalized exercise programme, at home or supervised.
Age and BMI were weakly associated; comorbidity, walking difficulty and wanting surgery were linked to smaller pain reduction or pain increase.
Key findings
01Mean pain change was -1.27 (SD 2.14) for knee OA and -0.98 (SD 2.34) for hip OA at 3 months, and -0.93 (SD 2.10) for knee OA and -0.47 (SD 2.32) for hip OA at 12 months on a 0 to 10 pain scale.
02Higher baseline pain was linked to a larger pain reduction, while age and BMI were linked to small positive changes, meaning less reduction or slight pain increase.
03Frequent daily or constant pain, Charnley class C, walking difficulty at 12 months, previous surgery to the index knee, previous physical therapy in knee OA and hip OA at 12 months, and willingness to undergo surgery were linked to positive coefficients, meaning smaller pain reduction or pain increase.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was an observational register cohort, not a randomized trial. It cannot show that the BOA intervention caused pain reduction or that any factor caused a worse outcome. 20,919 of 44,228 people who received a personalized exercise program were excluded for missing or late follow-up data. Excluded patients had similar baseline characteristics overall, except a higher prevalence of people willing to undergo joint replacement. Some baseline variables were missing and were assumed to be missing at random, but the reason for missing data could not be verified. Only pain change was analyzed. Physical function and other outcomes were not available in the register. The models explained a modest share of variation in pain change. Contextual factors such as therapist-patient relationship, expectations and preferences were not captured. Information on drug type, dose and plan was not recorded. Information on previous physical therapy content and sessions was also not recorded.
The easy way to misread this
Do not read the pain reductions as proof that the BOA programme caused them. This was an observational register cohort with no comparison group, and the authors state that causality cannot be established.