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Improved patient outcomes by a first-line osteoarthritis self-management program delivered digitally

      Purpose: To descriptively analyze outcomes of patients that had followed a first-line digitally delivered OA self-management program for 6 months.
      Methods: Data on people with hip- or knee osteoarthritis adhering (registered and exercising, taking part in lessons, filling out health forms during the whole period) to a digital self-management intervention program for 6 months were included. The intervention consisted of a digital, structured and individualized treatment program for people with hip or knee OA. The program contains instructions for neuromuscular exercises appropriately adjusted to each patient in regard to complexity and difficulty. Exercises are distributed daily during the 6 month period, in general two per day. Evidence-based information in the form of text or video on subjects related to OA, OA symptoms and management is also distributed to each participant, packed in themes. Continuous access to and dialogue with a physiotherapist through an encrypted chat function, and/or telephone, is provided. Demographic data, age, gender, Body Mass Index (BMI) and Numeric Rating Scale Pain (NRS 0-10) and data on whether the participant experienced improvement in symptoms or health (decreased pain, increased physical function, improved overall health, dichotomous replies yes/no) and whether the participant stopped taking OA-related medication (opioids, NSAID, paracetamol/acetaminophen, yes/no) at or around month 6 were extracted from the database. A variable number of the 6 month adhering patients did not report all outcomes at 6 months.
      Results: At the time of data extraction, a total of 2245 individuals had adhered for 6 months. 834 reported hip as their most troublesome joint and 1397 the knee (missing data for 14 patients). Their average age was 63 years ± 9 years, with 75% women. Average BMI was 27.5 ± 5. NRS pain (0-10) decreased from 5.65 ± 1.9 at start to 3.29 ± 2.1 at the 6 month follow-up. At 6 months 85% (950/1116) of patients reported pain improvement, 84% (941/1116) improvement of function and 69% (774/1116) reported an overall health improvement. Of those answering the question on whether medication was changed since start of the program (n=228), 42% reported that they had stopped taking medicine at 6 months.
      Conclusions: To tackle the increasing burden of OA and increase uptake of recommended first-line treatment, self-management programs have been developed. Despite their success in improving patients’ symptoms, limitations in their implementation result in these programs reaching only a minority of the OA population that would benefit. Digital self-management programs have been developed to facilitate access to first-line treatment for OA and to aid patients in maintaining a long-term exercise regime. Considering the positive results showed in this and previous studies, digital interventions may represent a viable alternative for patients without access to or not interested in participating in traditional face to face programs. Digital interventions such as the present one may help in enhancing long-term treatment adherence as well as facilitate continuous and lasting improvement of symptoms. Results from some exercise-based OA interventions suggest that knee OA patients experience a larger pain reduction, in comparison to those suffering from hip OA. In contrast to some previous research, in a recent cohort study (under review) we were unable to confirm this differential response to exercise of the knee and hip (data not shown). Since results are based on a register of patients voluntarily choosing whether to report their outcomes and when to drop out of treatment, reflecting clinical reality, some data is missing.