Implementing telehealth-delivered group-based education and exercise for osteoarthritis during the COVID-19 pandemic: A mixed-methods evaluation

ABSTRACT

Introduction: The Good Life with osteoArthritis from Denmark (GLAD) program provides group-based education (2 sessions) and exercise-therapy (12 sessions) for people with knee and hip osteoarthritis at >500 sites in Australia and is associated with clinically meaningful improvements in pain and quality of life (QoL). During the COVID-19 pandemic, physiotherapists in Australia were supported to provide GLAD via telehealth. The aim of this mixed-methods project was to evaluate the implementation of GLAD via telehealth. Method(s)Evaluation Framework Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST). Quantitative People with knee or hip osteoarthritis participating in GLAD via telehealth-only or a hybrid delivery of in-person and telehealth (>=3 telehealth sessions) from March 2020-October 2021. Mean differences (MD) and effect sizes (ES) from baseline to 3-month follow-up were calculated for average pain (0-100) and joint-related QoL (KOOS-QOL, HOOS-QOL sub-scales). Participants rated perceived recovery (global rating of change scale -3 to 3;1-3=recovered) and program satisfaction (scale 1-5;4,5=satisfied).Qualitative 23 GLAD trained physiotherapists (n=12 telehealth adopters;n=11 non-adopters) from diverse (private/public practice, urban/rural) settings completed one-on-one semi-structured interviews. Interviews were transcribed and analysed using a reflexive thematic approach. Results:Reach 138 people (39 telehealth-only and 99 hybrid delivery;69% female) participated in GLAD via telehealth.. Mean (SD) age and BMI were 64 (9) years and 29.8 (5.5) kg/m2, respectively. Identified barriers and enablers for reach included technology literacy and access, personal preference and perceived value of telehealth, and availability of exercise equipment. Pandemic restrictions to in-person GLAD was an enabler. Effectiveness Average pain decreased for telehealth-only (MD, 95%CI=-10, -16 to -4;ES=-0.54) and hybrid delivery (MD=-11, -16 to -6;ES=-0.43) GLAD. Joint-related QoL improved for telehealth-only (MD=9, 3 to 14;ES=0.51) and hybrid delivery (MD=12, 8 to 16;ES=0.65) GLAD. At 3-months, 81% of participants were recovered and 88% were satisfied. Most physiotherapists believed telehealth was as effective as in-person and felt patients were better able to continue exercising at home. Adoption 92 physiotherapists (74 health services) delivered GLAD via telehealth, most stating it had become a normal part of their practice. Adoption barriers included preferring, and greater confidence with providing, in-person GLAD. Implementation 70% (n=96) of participants attended both education sessions and 91% (n=125) attended >10 exercise-therapy sessions. Telehealth-delivered GLAD involved modifications to assessment, exercise instruction, equipment, and reduced fee structures. Maintenance Lack of personnel capacity, low patient demand, and a need for telehealth training and support were sustainability barriers. Discussion(s) Telehealth-delivered GLAD in Australia during the pandemic predominantly involved hybrid delivery. Patient outcomes following telehealth-delivered GLAD were comparable to published in-person registry data. However, implementation was limited, impeded by low perceived value by patients and lack of confidence and training of physiotherapists. Impact and application to the field * Telehealth-delivered group-based education and exercise provides a viable and effective option to provide people with osteoarthritis appropriate first-line care in Australia. * Findings highlight the need for, and can help guide, community education about the value of telehealth, alongside training to support physiotherapists delivering GLAD via telehealth. My co-authors and I have no conflict of interest related to the submission of this Copyright © 2022