RESUMO
OBJECTIVE: Patients with osteoarthritis are mainly managed in primary care settings and many patients use pain medication as symptomatic treatment. We investigated in OA-patients receiving an education and exercise program, the use and type of pain medication and its impact on outcomes at 3 months follow-up. DESIGN, SETTING AND SUBJECTS: The design was a retrospective cohort study using prospectively collected data from the GLA: D® registry. The study included 15,918 primary care patients. RESULTS: Among the included patients, 62% were pain medication users and 38% were non-users. Among the pain medications users, 35% were classified as paracetamol users, 54% as NSAID users, and 11% as opioid users. Medication users and non-users differed regarding a higher pain intensity, poorer physical and mental health. Pain medication use before and during the education and exercise program was associated with the pain intensity at 3 months follow-up. However, patients either using or not using pain medications improved over time, and the magnitude of the difference between patient groups was small (less than 10 mm on a 0-100 scale). CONCLUSIONS: Pain medication use is weakly associated with outcome at 3 months follow up in OA-patients receiving an education and exercise program. Between-group differences, however, are small and probably not clinically important.
Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Terapia por Exercício , Humanos , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/tratamento farmacológico , Dor , Estudos RetrospectivosRESUMO
BACKGROUND: Evidence on prognostic factors associated with progression to total hip replacement (THR) in hip osteoarthritis (OA) is for the most patient- and disease-specific characteristics either conflicting or inconclusive. Therefore, the objectives of this study of participants with hip OA enrolled in a structured program of supervised education and exercise therapy were to describe the rate of THR and to identify prognostic factors for receiving THR within the following 2 years. METHODS: Participants aged ≥ 45 years with hip OA enrolled in Good Life with osteoArthritis in Denmark (GLA:D®) from July 2014 to March 2017 were included. Potential prognostic factors included demographic and disease-specific baseline characteristics and measures of physical activity and quality of life (QoL). Information on THR was retrieved from The Danish National Patient Registry. A multivariable Cox proportional hazards model was developed. RESULTS: Of 3657 included participants, 30% received a THR within 2 years. Of the 100 participants already wait-listed for THR, 60% had the procedure. Of 22 candidate prognostic factors, 14 were statistically significant for receiving THR. Factors associated with a faster rate of THR included being "male" (HR 1.43), having "self-reported radiographic hip OA" (HR 2.32), being "wait-listed for THR" (HR 2.17), and having a higher "pain intensity" (HR 1.01). In contrast, faster "walking speed" (HR 0.64), better "hip-related QoL" (HR 0.98), and having "three or more comorbidities" (HR 0.62) were predictive of a slower rate of THR. CONCLUSION: During the 2-year follow-up period, 30% of the cohort received a THR. Notably, 40% of those wait-listed for THR when entering the program did not receive THR within 2 years. A number of baseline prognostic factors for receiving THR were identified.
Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Terapia por Exercício , Humanos , Osteoartrite do Quadril/cirurgia , Prognóstico , Qualidade de VidaRESUMO
OBJECTIVES: To investigate the impact of educational level and employment status on change in pain intensity after treatment among patients with knee and hip osteoarthritis (OA). DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: We analysed 22 588 patients participating in the Good Life with osteoArthritis in Denmark (GLA:D). GLA:D consists of two patient education sessions and 12 supervised exercise sessions. PRIMARY OUTCOME: Baseline educational level and employment status were used as exposures. We investigated the impact of both exposures separately on mean change in pain intensity (visual analogue scale 0-100 mm) from baseline to immediately after treatment (approximately 3 months) and at 12 months, using linear mixed models. RESULTS: On average, all patients improved in pain intensity. The average improvement in pain did not differ by educational level, except for one group. Patients with long-term education had less improvement after treatment (2.0 mm, 95% CI 0.8 to 3.1) and at 12 months (2.0 mm, 95% CI 0.6 to 3.4) compared with primary school only (reference). According to employment status, patients on sick leave had the greatest improvement in pain after treatment (-3.4, 95% CI -4.9 to -1.9) and at 12 months (-4.5, 95% CI -6.4 to -2.6) compared with retired patients (reference). CONCLUSIONS: On average, all patients reported improvement in pain at short-term and long-term follow-up. Change in pain intensity did not substantially differ by educational level or employment status, as the absolute differences were small and most likely not clinically important.
Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Emprego , Terapia por Exercício , Humanos , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Dor , Estudos ProspectivosRESUMO
OBJECTIVES: To investigate changes in analgesic use before and after supervised exercise therapy and patient education in patients with knee or hip osteoarthritis (OA). METHODS: We recruited 16 499 of 25 933 eligible patients (64%; mean age 64.9; SD 9.6; 73% women) from the Good Life with osteoArthritis in Denmark (GLA:D) registry. Change in proportions of analgesic users (categorised according to analgesic risk profile; opioids > non-steroidal anti-inflammatory drugs > paracetamol) was assessed from before to after an 8-week supervised exercise therapy and patient education programme targeting knee or hip OA pain and functional limitations. RESULTS: Patients reported 13.2 mm (95% CI 12.8 to 13.6) less pain (visual analogue scale 0-100 mm) at follow-up compared with baseline. The proportion of analgesic users reduced from 62.2% (95% CI 61.5 to 63.0) at baseline to 44.1% (95% CI 43.3 to 44.9) at follow-up (absolute change: 18.1% (95% CI 17.3 to 19.0)). Among patients using analgesics at baseline, 52% changed to a lower risk analgesic or discontinued analgesic use. The proportion of opioid users after the exercise therapy was 2.5% (95% CI 2.1 to 2.9) lower than baseline; this represents a relative reduction of 36%. CONCLUSION: Among patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.