Implementation of the Good Life with OsteoArthritis in Denmark (GLA:D®) Program across Canada for the Management of Hip and Knee Osteoarthritis

Zywiel, Michael G.; Ellis, Kira; Veillette, Christian; Skou, Søren Thorgaard; McGlasson, Rhona

doi:10.12927/hcq.2021.26464

Cited by 8 publications

(9 citation statements)

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“…This may have implications for first-line care initiatives aimed at reducing symptoms in individuals with symptomatic hip OA, suggesting a potential need for targeted and different approaches in male and female subjects. Interest in the 3-month time point in the study stemmed from findings that minimal-to-no further changes occur after this time point (i.e., scores are stable from month 3 through to month 12) (9,15,28). Not unlike descriptive reports in symptomatic hip and knee OA, in participants undergoing similar education and exercise programs (7,15), overall improvement in pain intensity was observed during program participation in the current sample.…”

Section: Discussionmentioning

confidence: 70%

Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis

Perruccio

Roos

Skou

et al. 2023

Arthritis Care & Research

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Objective To understand factors associated with pain intensity responder status following nonsurgical hip osteoarthritis (OA) intervention, according to sex. Methods Data were from individuals with hip OA participating in the Danish Good Life With Osteoarthritis in Denmark 8‐week education and exercise program. The following factors were recorded at program entry: age; education; mental well‐being; comorbidities; body mass index; symptoms in hip, knee, and low back; and program‐specific factors including education sessions, former participant lectures, and supervised exercise sessions. Pain intensity was recorded at baseline and at month 3 (post‐program) on a 0–100‐mm visual analog scale. Response was defined as pain intensity improvement of ≥30% from baseline to post‐program. Logistic regression was used and conducted separately in male and female subjects. Results The sample included 791 men and 2,253 women. Female subjects had a mean baseline pain score of 47.2 of 100 (95% confidence interval [95% CI] 46.4–48.1) and male subjects had a score of 41.7 (95% CI 40.3–43.1). By post‐program, the proportion of pain responders was 50.4% among women and 45.8% among men (difference P = 0.025). Among women, program‐specific factors (attending former participant lectures and more supervised exercise sessions) were positively associated with pain response, as were better mental well‐being and fewer comorbidities, while symptoms in other joints/sites were associated with a decreased likelihood of response. Among men, program‐specific factors were not associated with response, while better mental well‐being and fewer comorbidities were associated with being a responder. Conclusion Findings suggest that the influence of some factors on pain response differ for male and female subjects and point to a potential need for targeted approaches for men and women who may require different key messages/approaches from health care providers.

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Section: Discussionmentioning

confidence: 70%

Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis

Perruccio

Roos

Skou

et al. 2023

Arthritis Care & Research

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“…Patients are not eligible for the program if they have joint problems related to other conditions (eg, recent trauma, inflammatory disease, etc) or have other symptoms that are more pronounced than OA symptoms (eg, fibromyalgia). This Edu+Ex program is delivered predominately by physical therapists across Canada 23 . The group‐based program consists of 2 patient education sessions and 12 supervised exercise sessions delivered twice per week over 6 to 8 weeks 23,24 .…”

Section: Methodsmentioning

confidence: 99%

“…This Edu+Ex program is delivered predominately by physical therapists across Canada. 23 The group-based program consists of 2 patient education sessions and 12 supervised exercise sessions delivered twice per week over 6 to 8 weeks. 23,24 Educational topics include general knowledge about OA, common symptoms, treatment and self-management options, and how to improve general health.…”

Section: Methodsmentioning

confidence: 99%

“…23 The group-based program consists of 2 patient education sessions and 12 supervised exercise sessions delivered twice per week over 6 to 8 weeks. 23,24 Educational topics include general knowledge about OA, common symptoms, treatment and self-management options, and how to improve general health. The supervised exercise sessions are based on a neuromuscular exercise program aimed at promoting functional stabilization of the knee joint to help reduce pain and improve function.…”

Section: Methodsmentioning

confidence: 99%

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Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity‐Matched Analysis

Young,

Zywiel,

Skou

et al. 2024

Arthritis Care & Research

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ObjectiveTo estimate the treatment effect of total knee arthroplasty (TKA) versus an education and exercise (Edu+Ex) program on pain, function, and quality of life outcomes 3‐ and 12‐months after treatment initiation for knee osteoarthritis (OA).MethodsPatients with knee OA who had undergone TKA were matched on a 1:1 ratio with participants in a Edu+Ex program based on a propensity score fitted to a range of pre‐treatment covariates. After matching, between‐group differences in improvement (the treatment effect) in Knee injury and Osteoarthritis Outcome Score 12‐item version (KOOS‐12; 0 worst to 100 best) pain, function, and quality of life from baseline to 3‐ and 12‐months were estimated using linear mixed models, adjusting for unbalanced covariates, if any, after matching.ResultsThe matched sample consisted of 522 patients (Edu+Ex n=261; TKA n=261) that were balanced on all pre‐treatment characteristics. At 12‐month follow‐up, TKA resulted in significantly greater improvements in pain (mean difference [MD] 22.8; 95% CI 19.7 to 25.8), function (MD 21.2; 95% CI 17.7 to 24.4), and quality of life (MD 18.3; 15.0 to 21.6). Even so, at least one‐third of patients receiving Edu+Ex had a clinically meaningful improvement in outcomes at 12‐months compared to 75% of TKA patients.ConclusionTKA is associated with greater improvements in pain, function, and quality of life, but these findings also suggest that Edu+Ex may be a viable alternative to TKA in a meaningful proportion of patients, which may reduce overall TKA need. Confirmatory trials are needed.

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“…Initiated in Denmark, uptake of the GLA:D TM program has occurred in Australia, Switzerland, New Zealand, and Canada (GLAD International, 2021). The program has previously been translated from Danish into English and the program implementation has been feasibility tested in Canada (Davis et al., 2018; Zywiel et al., 2021). The effectiveness and safety of GLA:D TM was demonstrated in Danish adults with moderate to severe hip and knee OA (Skou, Bricca, & Roos, 2018; Svege et al., 2015).…”

Section: Introductionmentioning

confidence: 99%

Implementing a guideline‐based education and exercise program for people with knee and hip osteoarthritis—Practical experiences of providers and clinic leaders: A qualitative study

Kania‐Richmond,

Jones,

Martyn

et al. 2023

Musculoskeletal Care

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BackgroundThe Good Life with osteoArthritis: Denmark (GLA:DTM) program is an evidence‐based education and exercise program designed for individuals with symptomatic hip and knee osteoarthritis. Launched in Denmark, it has been implemented across Europe, Australia, and North America. The authors assessed the feasibility of GLADTM implementation in Canada (Alberta) by applying the RE‐AIM framework. An evaluation objective was to identify factors impacting the implementation of the program in both publicly funded and private rehabilitation settings, based on the experience of the initial cohort of providers and clinic leaders who set up and delivered the program.MethodsSemi‐structured telephone interviews were conducted with GLA:DTM‐trained providers, managers, or directors of clinics across Alberta. Braun and Clarke's thematic approach was used to code the data and identify emergent categories and themes. Those relevant to the implementation were identified and by consensus, categorized as facilitators of and challenges to the implementation process.ResultsEighteen GLA:DTM ‐trained providers and three clinic leaders from a range of clinical settings completed an interview. Seven common themes emerged in relation to implementation across the study settings. Three themes reflect facilitators of implementation (program acceptability by providers, multi‐level support mechanisms, and program flexibility) and four implementation challenges (direct and indirect costs, lack of external referrals, program access issues, and lack of suitable space). The initial implementation of the program was exploratory with limited focus on long‐term sustainability.ConclusionsThe GLA:DTM program is a translatable program that can be implemented with relative ease in both public and private rehabilitation settings; however, costs, space constraints, and having an adequate referral base were noted challenges. Further work is warranted to explore equitable access across public and private settings and program sustainability.

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Implementation of the Good Life with OsteoArthritis in Denmark (GLA:D®) Program across Canada for the Management of Hip and Knee Osteoarthritis

Cited by 8 publications

References 0 publications

Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis

Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis

Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity‐Matched Analysis

Implementing a guideline‐based education and exercise program for people with knee and hip osteoarthritis—Practical experiences of providers and clinic leaders: A qualitative study

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