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2015 HSR&D/QUERI National Conference Abstract

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3003 — Randomized Clinical Trial of a Patient and Provider Intervention for Managing Osteoarthritis in Veterans

Allen KD, Durham VA COIN; Bosworth HB, Durham VA COIN; Coffman CJ, Durham VA COIN; Datta SK, Durham VA COIN; Ike TI, Duke University; Jeffreys AS, Durham VA COIN; McDuffie J, Durham VA COIN; Strauss J, Durham VA COIN; Yancy WS, Durham VA COIN; Oddone EZ, Durham VA COIN

Objectives:
Osteoarthritis (OA) is a leading cause of pain and disability in Veterans, and multiple studies show gaps in the use of behavioral strategies and evidence-based components of clinical care for OA. The trial examined the effectiveness of a combined patient + provider intervention for managing OA in VA primary care.

Methods:
300 patients with hip and / or knee OA at the VA Medical Center in Durham, NC (mean age = 61, SD = 11; 91% male; 50% non-white) were randomized to a patient + provider intervention for managing OA versus usual care. The 12-month, telephone-based patient intervention focused on weight management, physical activity and cognitive behavioral pain management. The provider intervention involved delivery in the electronic medical record of patient-specific recommendations for OA treatments (based on published guidelines and including non-pharmacological treatments such as physical therapy). The primary outcome was the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) total score (range: 0-96, higher scores indicate worse pain, stiffness and function). Linear mixed models were used to assess the difference in improvement in outcomes between the intervention and usual care groups, adjusting for clustering within physicians. In addition, interaction terms were added to these models to examine whether treatment effects differed by participant age, race (white vs. non-white), gender, symptom duration, body mass index, and self-rated health.

Results:
At 12-month follow-up, WOMAC scores were 4.2 points lower in the intervention group vs. usual care [95% confidence interval = -7.2, -1.1; p = 0.008], indicating that the intervention resulted in improved OA symptoms. There were no variations in intervention effects for any of the participant characteristics examined (all interaction terms p > 0.05).

Implications:
This intervention improved symptoms in patients with hip and knee OA. Intervention effects were comparable across multiple participant characteristics, suggesting this program can benefit older patients and those with long-standing OA symptoms, for example.

Impacts:
The telephone-based patient intervention is relatively low-cost and could be disseminated widely in the VA, and the provider intervention could be integrated in the electronic medical record system. Implementation of these interventions could improve outcomes for the many veterans with OA.