Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis
Jönsson, Therese LU ; Dell'Isola, Andrea LU ; Lohmander, L Stefan LU
; Wagner, Philippe
LU
and Cronström, Anna
LU
(2022)
In JAMA Network Open
5(11).
- Abstract
Importance: Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.
Objective: To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention.
Design, Setting, and Participants: This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up... (More)
Importance: Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.
Objective: To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention.
Design, Setting, and Participants: This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021.
Exposures: Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application.
Main Outcomes and Measures: Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior.
Results: A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome.
Conclusions and Relevance: This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.
(Less)
- author
- Jönsson, Therese
LU
; Dell'Isola, Andrea
LU
; Lohmander, L Stefan
LU
; Wagner, Philippe
LU
and Cronström, Anna
LU
- organization
- publishing date
- 2022-11-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Humans, Female, Aged, Male, Osteoarthritis, Knee/therapy, Osteoarthritis, Hip/therapy, Quality of Life, Cohort Studies, Exercise Therapy, Pain/etiology
- in
- JAMA Network Open
- volume
- 5
- issue
- 11
- article number
- e2240126
- pages
- 12 pages
- publisher
- American Medical Association
- external identifiers
-
- pmid:36326763
- scopus:85141890660
- ISSN
- 2574-3805
- DOI
- 10.1001/jamanetworkopen.2022.40126
- language
- English
- LU publication?
- yes
- id
- 946c2ad8-893a-4bcc-8cbb-6e294d0c5886
- date added to LUP
- 2022-11-10 13:54:18
- date last changed
- 2024-05-02 16:33:43
@article{946c2ad8-893a-4bcc-8cbb-6e294d0c5886,
abstract = {{<p>Importance: Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.</p><p>Objective: To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention.</p><p>Design, Setting, and Participants: This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021.</p><p>Exposures: Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application.</p><p>Main Outcomes and Measures: Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior.</p><p>Results: A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome.</p><p>Conclusions and Relevance: This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.</p>}},
author = {{Jönsson, Therese and Dell'Isola, Andrea and Lohmander, L Stefan and Wagner, Philippe and Cronström, Anna}},
issn = {{2574-3805}},
keywords = {{Humans; Female; Aged; Male; Osteoarthritis, Knee/therapy; Osteoarthritis, Hip/therapy; Quality of Life; Cohort Studies; Exercise Therapy; Pain/etiology}},
language = {{eng}},
month = {{11}},
number = {{11}},
publisher = {{American Medical Association}},
series = {{JAMA Network Open}},
title = {{Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis}},
url = {{http://dx.doi.org/10.1001/jamanetworkopen.2022.40126}},
doi = {{10.1001/jamanetworkopen.2022.40126}},
volume = {{5}},
year = {{2022}},
}