Kelli D. Allen, PhD; Eugene Z. Oddone, MD, MHSc; Cynthia J. Coffman, PhD; Amy S. Jeffreys, MStat; Hayden B. Bosworth, PhD; Ranee Chatterjee, MD, MPH; Jennifer McDuffie, PhD; Jennifer L. Strauss; William S. Yancy Jr., MD, MHS; Santanu K. Datta, PhD, MHS; Leonor Corsino, MD, MHS; Rowena J. Dolor, MD, MHS
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).
Acknowledgment: The authors thank study team members Catherine Stanwyck, Carrie Bumgarner, Dorothea Brock, and Stephanie Smith, as well as the clinics of the Duke Primary Care (DPC) Research Consortium that participated in this study: DPC Butner–Creedmoor, DPC Henderson, DPC Hillsborough, DPC Pickett Road, DPC Harps Mill, DPC Timberlyne, Durham Medical Center, Oxford Family Physicians, Sutton Station Internal Medicine, and Triangle Family Practice. The authors also are deeply grateful to all the patients who participated in this study.
Financial Support: By the NIAMS of the NIH under award 1R01AR059673-01 and contributions from the Department of Veterans Affairs Health Services Research and Development Service (CIN 13-410).
Disclosures: Drs. Allen, Coffman, Dolor, and Datta report grants from the NIH during the conduct of the study. Dr. Bosworth reports grants and personal fees from Sanofi; grants from Johnson and Johnson, Takeda, and Improved Patient Outcomes; and personal fees from Genentech, outside the submitted work. Dr. Yancy reports grants from NIH/NIAMS during the conduct of the study; personal fees from University of Pennsylvania/Weight Watchers International; and grants from the NIH and Department of Veterans Affairs, outside the submitted work. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1245.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Allen (e-mail, email@example.com). Statistical code and data set: Available to approved persons through agreement with the authors (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Kelli D. Allen, PhD, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, CB# 7280, Chapel Hill, NC 27599; e-mail, email@example.com.
Current Author Addresses: Dr. Allen: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, CB# 7280, Chapel Hill, NC 27599.
Drs. Oddone, Coffman, Jeffreys, Bosworth, and McDuffie: Health Services Research and Development (152), Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.
Drs. Chatterjee, Datta, and Dolor: Duke Division of General Internal Medicine, 411 West Chapel Hill Street, Box 104427, Durham, NC 27710.
Ms. Strauss: Building 6, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.
Dr. Yancy: Duke Diet and Fitness Center, 501 Douglas Street, Durham, NC 27705.
Dr. Corsino: Duke Department of Medicine, Box 3451, Durham, NC 27710.
Author Contributions: Conception and design: K.D. Allen, E.Z. Oddone, C.J. Coffman, A.S. Jeffreys, H.B. Bosworth, J.L. Strauss, W.S. Yancy, S.K. Datta, R.J. Dolor.
Analysis and interpretation of the data: K.D. Allen, C.J. Coffman, A.S. Jeffreys, H.B. Bosworth, J. McDuffie, W.S. Yancy, S.K. Datta, R.J. Dolor.
Drafting of the article: K.D. Allen, C.J. Coffman, H.B. Bosworth, J. McDuffie, L. Corsino.
Critical revision for important intellectual content: K.D. Allen, E.Z. Oddone, C.J. Coffman, A.S. Jeffreys, H.B. Bosworth, R. Chatterjee, W.S. Yancy, L. Corsino, R.J. Dolor.
Final approval of the article: K.D. Allen, E.Z. Oddone, C.J. Coffman, A.S. Jeffreys, H.B. Bosworth, R. Chatterjee, J. McDuffie, J.L. Strauss, W.S. Yancy, S.K. Datta, L. Corsino, R.J. Dolor.
Provision of study materials or patients: R. Chatterjee, S.K. Datta, R.J. Dolor.
Statistical expertise: C.J. Coffman, A.S. Jeffreys.
Obtaining of funding: K.D. Allen, C.J. Coffman, S.K. Datta.
Administrative, technical, or logistic support: K.D. Allen, E.Z. Oddone, A.S. Jeffreys, J. McDuffie, R.J. Dolor.
Collection and assembly of data: K.D. Allen, C.J. Coffman, A.S. Jeffreys, J. McDuffie, S.K. Datta, R.J. Dolor.
A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.
To examine whether patient-based, provider-based, and patient–provider interventions improve osteoarthritis outcomes.
Cluster randomized trial with assignment to patient, provider, and patient–provider interventions or usual care. (ClinicalTrials.gov: NCT01435109)
10 Duke University Health System community-based primary care clinics.
537 outpatients with symptomatic hip or knee osteoarthritis.
The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers.
The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups.
No difference was observed in WOMAC score changes from baseline to 12 months in the patient (−1.5 [95% CI, −5.1 to 2.0]; P = 0.40), provider (2.5 [CI, −0.9 to 5.9]; P = 0.152), or patient–provider (−0.7 [CI, −4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, −3.7 to −7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care.
The study involved 1 health care network. Data on provider referrals were not collected.
Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Kelli D. Allen, Eugene Z. Oddone, Cynthia J. Coffman, Amy S. Jeffreys, Hayden B. Bosworth, Ranee Chatterjee, et al. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial. Ann Intern Med. 2017;166:401–411. doi: 10.7326/M16-1245
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Published: Ann Intern Med. 2017;166(6):401-411.
Published at www.annals.org on 17 January 2017
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