PLOS Medicine 16 12 : e To improve quality of care for patients with hip and knee osteoarthritis OA , a structured model for integrated OA care was developed based on international recommendations. The objective of this study was to assess the effectiveness of this model in primary care. We conducted a cluster-randomised controlled trial with stepped-wedge cohort design in 6 Norwegian municipalities clusters between January and October The randomised order was concealed to the clusters until the time of crossover from the control to the intervention phase.
The intervention was implementation of the SAMBA model, facilitated by interactive workshops for general practitioners and physiotherapists with an update on OA treatment recommendations. Patients in the intervention group attended a physiotherapist-led OA education and individually tailored exercise programme for 8β12 weeks. Among these, patients were recruited during the control periods control group , and patients were recruited during interventions periods intervention group.
The patients in the intervention group reported significantly higher quality of care score of 60 versus 41, mean difference The increase in quality of care was close to, but below, the pre-specified minimal important change.
In the intervention group, a higher proportion was referred to physiotherapy OR 2. Study limitations include the imbalance in patient group size, which may have been due to an increased attention to OA patients among the health professionals during the intervention phase, and a potential recruitment bias as the patient participants were identified by their health professionals.
In this study, a structured model in primary care resulted in higher quality of OA care as compared to usual care. Future studies should explore ways to implement the structured model for integrated OA care on a larger scale.
