A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans A Randomized Clinical Trial
A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans A Randomized Clinical Trial
复制标题
DOI：
10.7326/m15-0378
复制
发表时间：
2016-01-19
影响因子：
39.2
通讯作者：
Oddone, Eugene Z.
中科院分区：
文献类型：
--
作者：
Allen, Kelli D.;Yancy, William S., Jr.;Oddone, Eugene Z.
工作背景：骨关节炎的管理需要医疗和行为的策略，但一些推荐的疗法是underused.Objective：要检查的有效性相结合的患者和供应商的干预措施，以改善骨关节炎outcomes.Design：群集随机临床试验，分配到骨关节炎干预和常规护理组。（临床试验政府网站：NCT 01130740）设置：退伍军人事务部医疗中心在达勒姆，北卡罗来纳州。参与者：30个供应商（集群）和300个有症状的髋关节或膝关节骨关节炎门诊患者。干预：基于电话的患者干预集中在体重管理，体力活动，和认知行为疼痛管理。供应商的干预涉及提供患者特定的骨关节炎治疗建议，通过电子medical records.Measurements的初级保健providers：主要结果是总评分的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）在12个月。次要结局为WOMAC功能和疼痛子量表评分、体能（短期体能测试）和抑郁症状（患者健康问卷-8）。线性混合模型，调整集群的供应商评估组间差异，改善outcome.Results：在12个月，WOMAC评分低4.1分（表明改善），骨关节炎干预组与常规护理（95%CI，-7.2至-1.1点; P = 0.009）。干预组的WOMAC功能子量表评分低3.3分（CI，-5.7至-1.0分; P = 0.005）。WOMAC疼痛子量表评分（P = 0.126）、身体表现和抑郁症状在两组之间没有差异。虽然更多的患者在骨关节炎干预组接受推荐的骨关节炎治疗的供应商转介，谁收到他们的数字并没有difficulties.Limitation：该研究是在一个单一的退伍军人事务部medical center.Conclusion：合并患者和供应商的干预导致适度改善髋关节和膝关节骨关节炎患者自我报告的身体功能。
Background: Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused.Objective: To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes.Design: Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740)Setting: Department of Veterans Affairs Medical Center in Durham, North Carolina.Participants: 30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis.Intervention: The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record.Measurements: The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes.Results: At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ.Limitation: The study was conducted in a single Veterans Affairs medical center.Conclusion: The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.