The Supported Osteoarthritis Self-Management Programme in primary health care. Patient-reported outcomes and physiotherapists´ experiences

Sammanfattning: Abstract Background: Osteoarthritis (OA) is a disabling joint disease affecting about 300 million people worldwide. Today, there is no cure for OA and treatment focuses on relieving symptoms. Guidelines recommend education, exercise, and weight control, as first-line treatment. In Sweden, first-line treatment is offered as a Supported Osteoarthritis Self-Management Programme (SOASP) combining education and exercise with the aim of supporting patients with hip and/or knee OA to cope with their disease, improve health-related quality of life (HRQoL) and increase physical activity level. The overall aim of this thesis was to increase knowledge about the SOASP delivered in clinical settings in primary health care from the perspectives of patients and physiotherapists.Methods: All patients included in studies I–III had participated in a SOASP. Study I was based on a cohort (n = 7628) from the Swedish National Quality Registry, Better Management of patients with Osteoarthritis (BOA). Outcome measures were physical activity and HRQoL measured with the EQ-5D. Studies II and III were based on a cohort (n = 143) from two regions in the south of Sweden (Region Skåne and Region Blekinge). Outcome measures were enablement (PEI), empowerment (SWE-RES-23) and HRQoL (EQ-5D). In study IV, a purposive sampling was used. Eighteen physiotherapists were interviewed about their experiences of delivering the SOASP and about implementation of the treatment guidelines in Region Skåne. A patient partner was involved in studies II and III. Results: A greater proportion of men changed to being physically active at three months follow-up. The proportion of women being physically active ≥ 150 activity minutes a week was larger than for men at baseline and at follow-up at 12 months. Women reported lower HRQoL than men at all measuring points. Patients reported moderate to high enablement and empowerment and an increase in empowerment and in HRQoL after participating in a SOASP. Enablement and empowerment as measured with the PEI and the SWE-RES-23 respectively were only partly related and could not predict change in HRQoL among patients participating in a SOASP. The interviewed physiotherapists were confident in their role as primary assessors of OA patients and the guidelines were aligned with their professional beliefs. The SOASP, was found to be efficient for patients. Physiotherapists followed the guidelines, but saw room for improvement as all patients with hip and/or knee OA did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management’s support and that guidelines should be easy to follow.Conclusions: There were differences between men and women before and after participating in a SOASP. These differences should be considered when planning for how to support men and women with hip and/or knee OA to maintain or even increase physical activity and HRQoL in the long term. The results indicate that the SOASP is useful in enabling and empowering patients, at least in the short term, and that both the PEI and the SWE-RES-23 can be of use in evaluating interventions like SOASP. More research is needed to find outcome measures to predict OA treatment outcomes. The physiotherapists believed in the guidelines and were confident in providing first-line treatment to OA patients. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from the national quality registry on OA could probably be used to a greater extent in daily clinical work in primary health care to improve quality of care for OA patients.