Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials
Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials
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DOI：
10.1186/1471-2474-13-60
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发表时间：
2012-04-24
影响因子：
2.3
通讯作者：
Yancy, William S., Jr.
中科院分区：
文献类型：
--
作者：
Allen, Kelli D.;Bosworth, Hayden B.;Yancy, William S., Jr.
背景：髋部和膝部骨关节炎 (OA) 是最常见的慢性疾病之一，会导致严重疼痛和功能限制。 OA 的充分管理需要结合医疗和行为策略。然而，一些推荐的疗法在临床环境中并未得到充分利用，大多数髋关节和膝关节 OA 患者体重超重且缺乏运动。因此，提供者层面和患者层面的干预措施都有可能改善结果。本手稿描述了在两个不同的医疗保健系统中进行的两项正在进行的随机临床试验，研究了在初级保健中管理髋关节和膝关节 OA 的基于患者和基于提供者的干预措施。方法/设计：一项研究正在退伍军人事务部 (VA) 医疗保健系统内进行，并将比较患者和提供者联合干预相对于 n = 300 名患者（30 名初级保健提供者中每人 10 名）的常规护理的常规护理。杜克初级保健研究联盟正在开展另一项研究，该研究将在 10 个诊所的 560 名患者中比较仅患者、仅提供者和组合（患者 + 提供者）干预措施相对于常规护理的情况。这些研究的参与者有髋部或膝部骨关节炎的临床和/或放射学证据，体重超标，并且不符合当前的体力活动指南。为期 12 个月的基于电话的患者干预重点是体力活动、体重管理和认知行为疼痛管理。提供者干预包括根据循证指南提供针对患者的具体护理建议（例如转诊物理治疗、护膝、关节注射）。结果是在基线、6 个月和 12 个月时收集的。主要结果是西安大略大学和麦克马斯特大学骨关节炎指数（自我报告的疼痛、僵硬和功能），次要结果是简短的身体表现测试方案（客观身体功能）和患者健康问卷 8（抑郁症状）。干预措施的成本效益也将得到评估。讨论：这两项研究的结果将进一步加深我们对改善初级保健机构中髋部和膝部 OA 结局的最有效策略的理解。
Background: Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care.Methods/Design: One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and/or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e. g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed.Discussion: Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings.