Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide.
Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide.
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DOI：
10.1186/s12891-017-1439-y
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发表时间：
2017-02-07
影响因子：
2.3
通讯作者：
Roos EM
中科院分区：
文献类型：
--
作者：
Skou ST;Roos EM
在骨关节炎（OA）和其他慢性疾病的临床实践中采用循证指南是次优的。丹麦骨关节炎患者的美好生活（GLA：D）于2013年启动，旨在在全国范围内的临床护理中实施膝关节和髋关节OA治疗指南。本报告的目的是使用来自国家GLA：D登记研究的数据，评价2013年至2015年GLA：D干预措施的效果。病人接受教育和监督的运动提供训练有素的物理治疗师。基线、3个月和12个月时评价的结局为疼痛强度（0到100，最好到最差），客观身体功能（30秒椅立试验和40米快节奏步行试验），体力活动（每周至少进行30分钟体力活动的天数），生活质量（膝关节损伤和骨关节炎结局评分（KOOS）和髋关节残疾和骨关节炎结局评分（HOOS）生活质量子量表，0-100，从最差到最好）、服用止痛药和请病假的病人人数以及根据准则获得护理的情况。在分析中使用了来自GLA：D登记研究的9，825名参与者的数据。结果表明，GLA：D在3个月时疼痛强度和生活质量分别改善了12.4分和5.4分，在12个月时分别改善了13.7分和9.4分。此外，与GLA：D前一年相比，身体功能和身体活动改善（仅在3个月时），治疗后服用止痛药的患者减少，GLA：D后12个月时休病假的患者减少。在丹麦的所有五个医疗保健地区，通过286个有效的GLA：D单位提供GLA：D，但丹麦各城市的采用率仍然很低，只有20%的城市提供GLA：D。GLA：D在推出三年后已在全国范围内推广，不仅对患者症状和身体功能产生了重大影响，而且对止痛药的摄入和病假也产生了重大影响。通过教育和监督锻炼引入的生活方式改变在很大程度上维持在1年，并且可能也有可能改善总体健康状况并降低社会成本。
The uptake of evidence-based guidelines in clinical practice is suboptimal in osteoarthritis (OA) and other chronic diseases. Good Life with osteoArthritis in Denmark (GLA:D) was launched in 2013 with the aim of implementing guidelines for the treatment of knee and hip OA in clinical care nationwide. The purpose of this report was to evaluate the effects of the GLA:D intervention from 2013 to 2015, using data from the national GLA:D registry. Patients undergo education and supervised exercise delivered by trained physiotherapists. Outcomes evaluated at baseline, 3 and 12 months are pain intensity (0 to 100, best to worst), objective physical function (30-s chair-stand test and 40-m fast-paced walk test), physical activity (number of days per week being physically active for at least 30 min), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) quality of life subscale, 0–100, worst to best), number of patients on painkillers and sick leave, and access to care according to guidelines. Data from 9,825 participants from the GLA:D registry were utilised in the analyses. It was demonstrated that GLA:D improved pain intensity and quality of life by 12.4 points and 5.4 points at 3 months, and 13.7 points and 9.4 points at 12 months, respectively. Furthermore, physical function and physical activity improved (only at 3 months), fewer patients took painkillers following the treatment, and fewer patients were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D. GLA:D is offered in all five health care regions in Denmark via 286 active GLA:D units, but the uptake in the Danish municipalities is still low with only 20% of the municipalities offering GLA:D. Three years after its inception, GLA:D has been rolled out nationwide and has a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave. The lifestyle changes introduced by education and supervised exercise were largely maintained at 1 year and may have the potential to also improve general health and reduce societal costs.