A ‘joint’ approach: design, implementation and preliminary outcomes of an early conservative knee and hip osteoarthritis service in northern New South Wales, Australia
Brayden Campbell A * , Luke Schultz B * , Evan Bryant A , Jason D. Tsung A , Brett Lynam C and Alexandre S. Stephens
B D E F
+ Author Affiliations
- Author Affiliations
A Northern New South Wales Local Health District, Tweed Heads, NSW 2485, Australia.
B Northern New South Wales Local Health District, Lismore, NSW 2480, Australia.
C Healthy North Coast, North Coast Primary Health Network, Tweed Heads, NSW 2485, Australia.
D School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
E School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia.
F Corresponding author. Email: alexandre.stephens@health.nsw.gov.au
Australian Journal of Primary Health 28(2) 164-171 https://doi.org/10.1071/PY20309
Submitted: 21 December 2020 Accepted: 12 November 2021 Published: 22 February 2022
Abstract
Australia is facing a growing burden of knee and hip osteoarthritis (OA). To address this demand in northern New South Wales, a community health-based conservative OA joint management service was established in the Tweed Valley. This paper describes the design, implementation and initial evaluation of the service. Following the principles of clinical redesign, a diagnostic phase involving consultation with key stakeholders revealed several issues. OA patients could wait up to 9 months for review by orthopaedic specialist following GP referral and received limited information on how to conservatively manage their conditions. GPs were constrained by short consultations and had limited knowledge of the latest recommendations for the conservative treatment of OA. GPs also highlighted the limitations of outdated fax systems for communication, noting their preference for secure electronic messaging. Based on these findings, the Tweed Knee and Hip Arthritis Service was established. For patients not on a waiting list for surgery, the service provides evidence-based conservative management for knee or hip OA involving standardised assessment, education, exercise, self-management strategies and regular review. An analysis of a foundational cohort of patients demonstrated improvements in a suite of validated and standardised measures for pain and function, with improvements seen as early as 1 month and sustained for 6 months. The study findings support the introduction of integrated conservative OA management models of care directly available to primary healthcare providers.
Keywords: clinical redesign, conservative management, osteoarthritis, stakeholder engagement.
References
Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA, De Steiger R (2019) The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskeletal Disorders 20, 90| The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030.Crossref | GoogleScholarGoogle Scholar | 30797228PubMed |
Agency for Clinical Innovation (ACI) (2012) Osteoarthritis Chronic Care Program Model of Care. (ACI: Sydney, NSW, Australia) Available at https://www.aci.health.nsw.gov.au/resources/musculoskeletal/osteoarthritis_chronic_care_program/osteoarthritis-chronic-care-program [Verified 9 September 2020]
Agency for Clinical Innovation (ACI) (2017) Centre for Healthcare Redesign Projects. (ACI: Sydney, NSW, Australia) Available at https://aci.health.nsw.gov.au/innovation-exchange/type-chr [Verified 3 May 2021]
Agency for Clinical Innovation (ACI) (2020) Redesign – Methodology for improvement and innovation | Agency for Clinical Innovation. (ACI: Sydney, NSW, Australia) Available at https://www.aci.health.nsw.gov.au/resources/redesign/redesign-factsheets/redesign-methodology-for-improvement-and-innovation [Verified 9 September 2020]
Australian Bureau of Statistics (ABS) (2018) National Health Survey: first results. (ABS: Canberra, ACT, Australia) Available at https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Arthritis%20and%20osteoporosis~30 [Verified 9 September 2020]
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ, National Joint Registry for England and Wales (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. The Journal of Bone and Joint Surgery. British Volume 89-B, 893–900.
| The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales.Crossref | GoogleScholarGoogle Scholar |
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage 27, 1578–1589.
| OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.Crossref | GoogleScholarGoogle Scholar | 31278997PubMed |
Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2, e000435
| What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients.Crossref | GoogleScholarGoogle Scholar | 22357571PubMed |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L (2016) Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization World Report on Ageing and Health. The Gerontologist 56, S243–S255.
| Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization World Report on Ageing and Health.Crossref | GoogleScholarGoogle Scholar | 26994264PubMed |
Brown C, Gordon B, Bucknill A (2012) The impact of the osteoarthritis hip and knee service (oahks) in melbourne health: a review from 2006–2009. Orthopaedic Proceedings 94-B, 222–222.
Cavka B, Ackerman I, Tacey M, Wicks I, Bucknill A, Brand C (2015) Mixed methods evaluation of a comprehensive osteoarthritis hip and knee service; patient, clinician and administrative perspectives – ClinicalKey. (Elsevier: Amsterdam, The Netherlands) Available at https://www.oarsijournal.com/article/S1063-4584(15)01118-8/fulltext [Verified 9 September 2020]
de Jong ORW, Hopman-Rock M, Tak ECMP, Klazinga NS (2004) An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip. Health Education Research 19, 316–325.
| An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip.Crossref | GoogleScholarGoogle Scholar |
Deloitte Access Economic (2014) Osteoarthritis Chronic Care Program Evaluation. (Deloitte Access Economics: Canberra, ACT, Australia) Available at http://eih.health.nsw.gov.au/__data/assets/pdf_file/0008/570869/OACCP-evaluation-feb-2015.pdf [Verified 9 September 2020]
Dobson F, Hinman RS, Roos EM, Abbott JH, Stratford P, Davis AM, Buchbinder R, Snyder-Mackler L, Henrotin Y, Thumboo J, Hansen P, Bennell KL (2013) OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis and Cartilage 21, 1042–1052.
| OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis.Crossref | GoogleScholarGoogle Scholar | 23680877PubMed |
Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152, 2399–2404.
| Validity of four pain intensity rating scales.Crossref | GoogleScholarGoogle Scholar | 21856077PubMed |
Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL (2015) Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine 49, 1554–1557.
| Exercise for osteoarthritis of the knee: a Cochrane systematic review.Crossref | GoogleScholarGoogle Scholar | 26405113PubMed |
Glauser TA, Salinas GD, Roepke NL, Williamson JC, Reese A, Gutierrez G, Abdolrasulnia M (2011) Management of mild-to-moderate osteoarthritis: a study of the primary care perspective. Postgraduate Medicine 123, 126–134.
| Management of mild-to-moderate osteoarthritis: a study of the primary care perspective.Crossref | GoogleScholarGoogle Scholar | 21293093PubMed |
Harris KK, Dawson J, Jones LD, Beard DJ, Price AJ (2013) Extending the use of PROMs in the NHS—using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study. BMJ Open 3, e003365
| Extending the use of PROMs in the NHS—using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study.Crossref | GoogleScholarGoogle Scholar | 23965934PubMed |
HealthStats NSW (2020) Overweight or obesity in adults by Local Health District, trends. (HealthStats NSW: Sydney, NSW, Australia) Available at https://www.healthstats.nsw.gov.au/#/indicator?name=-beh-bmi-cat-oo-phs&location=LHD&view=Trend&measure=prevalence&groups=Body%20mass%20index,Sex&compare=Body%20mass%20index,LHD&filter=Body%20mass%20index,Overweight%20or%20obese,Overweight,Obese&filter=Sex,Persons&filter=LHD,All%20LHDs [Verified 21 February 2022]
Ingelsrud LH, Roos EM, Terluin B, Gromov K, Husted H, Troelsen A (2018) Minimal important change values for the Oxford Knee Score and the Forgotten Joint Score at 1 year after total knee replacement. Acta Orthopaedica 89, 541–547.
| Minimal important change values for the Oxford Knee Score and the Forgotten Joint Score at 1 year after total knee replacement.Crossref | GoogleScholarGoogle Scholar | 29860936PubMed |
Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. The Journal of Bone and Joint Surgery. British Volume 89-B, 1010–1014.
| The use of the Oxford hip and knee scores.Crossref | GoogleScholarGoogle Scholar |
National Health and Medical Research Council (NHMRC) (2018) National Statement on Ethical Conduct in Human Research (2007) – updated 2018. (NHMRC: Canberra, ACT, Australia) Available at https://www.nhmrc.gov.au/about-us/publications/national-statement-ethical-conduct-human-research-2007-updated-2018 [Verified 9 September 2020]
Pitt VJ, O’connor D, Green S (2008) Referral of people with osteoarthritis to self-management programmes: barriers and enablers identified by general practitioners. Disability and Rehabilitation 30, 1938–1946.
| Referral of people with osteoarthritis to self-management programmes: barriers and enablers identified by general practitioners.Crossref | GoogleScholarGoogle Scholar | 18608407PubMed |
Royal Australian College of General Practitioners (RACGP) (2018) Guideline for the management of knee and hip osteoarthritis. (RACGP: Melbourne, Vic., Australia) Available at http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf [Verified 9 November 2020]
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W (2004) Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain (London, England) 8, 283–291.
| Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.Crossref | GoogleScholarGoogle Scholar |
Schofield D, Shrestha R, Cunich M (2016) Counting the cost: the current and future burden of arthritis. Part 2. Economic costs. Available at https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final-Counting-the-Costs_Part2_MAY2016.pdf [Verified 4 February 2022]
Skou ST, Roos EM (2017) Good Life with osteoArthritis in Denmark (GLA:DTM): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskeletal Disorders 18, 72
| Good Life with osteoArthritis in Denmark (GLA:DTM): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide.Crossref | GoogleScholarGoogle Scholar | 28173795PubMed |
Tweed Shire Council (2020) Population and age structure, Tweed Shire Council, population forecast. (Tweed Shire Council: Tweed Heads, NSW, Australia) Available at https://forecast.id.com.au/tweed/population-age-structure?AgeTypeKey=3 [Verified 9 September 2020]
Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision? International Orthopaedics 32, 597–604.
| Total hip arthroplasties: what are the reasons for revision?Crossref | GoogleScholarGoogle Scholar | 17443324PubMed |
Willis-Owen CA, Konyves A, Martin DK (2010) Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. The Journal of Bone and Joint Surgery. British Volume 92-B, 1128–1133.
| Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases.Crossref | GoogleScholarGoogle Scholar |
