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Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis - PubMed

  • ️Fri Jan 01 2021

Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis

Christian J Barton et al. Osteoarthr Cartil Open. 2021.

Abstract

Objective: Evaluate the implementation of Good Life with osteoArthritis from Denmark (GLA:D®) for knee osteoarthritis in Australia using the RE-AIM QuEST (Reach, Effectiveness, Adoption, Implementation, Maintenance Qualitative Evaluation for Systematic Translation) framework.

Design: Physiotherapists completed surveys before and after GLA:D® training (2017-2020) to assess practices, and barriers and enablers to implementation. Patients completed online baseline, 3-month (post-treatment) and 12-month patient reported outcomes. Effective implementation was defined as within-participant moderate effect size (ES, ≥0.50) for average pain (100 ​mm VAS) and Knee Injury and Osteoarthritis Outcome Score quality of life scores (KOOS-QoL), and small effect size (≥0.20) for health-related quality of life (EQ-5D-5L).

Results: Reach : 1064 physiotherapists and 1945 patients from all states and territories participated. Key barriers included out-of-pocket cost to patients, and program suitability for culturally and linguistically diverse communities. Effectiveness: Following training, more physiotherapists reported discussing treatment goals and weight management, and prescribing supervised, neuromuscular exercise. Patient outcomes at 3- and 12-months (n ​= ​1044 [54%] and 927 [48%]) reflected effective implementation, including reduced pain (ES, 95%CI ​= ​0.72, 0.62-0.84; and 0.65, 0.54-0.77) and improved KOOS-QoL (0.79, 0.69-0.90; and 0.93, 0.81-1.04) and EQ-5D-5L (0.43, 0.31-0.54; and 0.46, 0.35-0.58) scores. Adoption: 297 sites (264 private, 33 public) implemented GLA:D®. Implementation: Most patients completed at least one education (90%), and 10 exercise-therapy (78%) sessions. Adequate staffing to support program delivery was a key enabler. Maintenance: 99% of sites (293/297) continued offering the program in July 2020.

Conclusion: Training changed practice and was associated with effective widespread implementation of GLA:D® in Australia.

Keywords: Education; Exercise; Implementation; Osteoarthritis; Physiotherapy; Program evaluation.

© 2021 The Authors.

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Conflict of interest statement

CJB, JLK and KMC are program leads of GLA:D® Australia, which is a not for profit implementation initiative. Their institution has received payment for training GLA:D® practitioners. ER and STS are the co-founders of Good Life with Osteoarthritis in Denmark (GLA:D®), a not for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. STS has received grants from The 10.13039/501100003554Lundbeck Foundation, personal fees from Munksgaard and TrustMe-ED, all of which are outside the submitted work. The authors affirm that they have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript.

Figures

Fig. 1a
Fig. 1a

Average pain in the previous month (measured on 100 ​mm visual analogue scale) at baseline, 3-months and 12-months.

Fig. 1b
Fig. 1b

Knee-related quality of life (measured by the Knee Injury and Osteoarthritis Outcome Score quality of life [KOOS-QoL] subscale) at baseline, 3-months and 12-months.

Fig. 1c
Fig. 1c

Health-related quality of life (measured by European Quality of Life-5 dimensions-5 levels [EQ-5D-5L]) utility score at baseline, 3-months and 12-months.

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