Pharmacist‐initiated intervention trial in osteoarthritis: A multidisciplinary intervention for knee osteoarthritis

Abstract

Objective. Knee osteoarthritis (OA) is a commonly undiagnosed condition and care is often not provided. Pharmacists are uniquely placed for launching a multidisciplinary intervention for knee OA. Methods. We performed a cluster randomized controlled trial with pharmacies providing either intervention care or usual care (14 and 18 pharmacies, respectively). The intervention included a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise, and communication with the primary care physician. Usual care consisted of an educational pamphlet. The primary outcome was the pass rate on the Arthritis Foundation's quality indicators for OA. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lower Extremity Function Scale (LEFS), the Paper Adaptive Test-5D (PAT-5D), and the Health Utilities Index Mark 3 (HUI3). Results. One hundred thirty-nine patients were assigned to the control (n ‫؍‬ 66) and intervention (n ‫؍‬ 73) groups. There were no differences between the groups in baseline measures. The overall quality indicator pass rate was significantly higher in the intervention arm compared to the control arm (difference of 45.2%; 95% confidence interval 34.5, 55.9). Significant improvements were observed for the intervention care group as compared to the usual care group in the WOMAC global, pain, and function scores at 3 and 6 months (all P < 0.01); the PAT-5D daily activity scores at 3 and 6 months (both P < 0.05); the PAT-5D pain scores at 6 months (P ‫؍‬ 0.05); the HUI3 single-attribute pain scores at 3 and 6 months (all P < 0.05); and the LEFS scores at 6 months (P < 0.05). Conclusion. Pharmacists can launch a multidisciplinary intervention to identify knee OA cases, improve the utilization of treatments, and improve function, pain, and quality of life.

Relationship between biological factors and catastrophizing and clinical outcomes for female patients with knee osteoarthritis

“…Furthermore, a number of studies have examined whether pain catastrophizing is an active cognitive process variable in multidisciplinary pain treatment settings, and have shown that pre- to post-treatment reductions in pain catastrophizing are associated with reductions in pain severity[40-42]. Indeed, Marra et al[43] have reported that multidisciplinary intervention for knee OA was superior to usual care with an educational pamphlet in terms of overall improvements, pain and function scores according to the Western Ontario and McMaster Universities’ Osteoarthritis Index.…”

Cost‐Utility Analysis of a Multidisciplinary Strategy to Manage Osteoarthritis of the Knee: Economic Evaluation of a Cluster Randomized Controlled Trial Study

“…Patient enrollment criteria have been described in detail elsewhere (4). The Clinical Research Ethics Board at the University of British Columbia approved the study protocol and all patients gave written informed consent before inclusion.…”

“…Pharmacists have been shown to have the ability to identify community-dwelling adults with undiagnosed OA of the knee and launch interventions that lead to improvements in pain, function, and health-related quality of life (4,5).…”

“…The Pharmacist-Initiated Intervention Trial in Osteoarthritis (PhIT-OA) study was a cluster randomized controlled trial designed to investigate whether pharmacists, upon finding untreated knee OA in clients who frequented their pharmacies, could improve quality of care and quality of life by launching a multidisciplinary intervention compared to usual care (4). The multidisciplinary intervention included the administration of a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise, and communication with the client's primary care physician.…”

Translating Evidence for Low Back Pain Management into a Consumer-Focussed Resource for Use in Community Pharmacies: A Cluster-Randomised Controlled Trial

“…Community pharmacies may represent a potentially under-utilised health workforce for providing accessible and evidence-based information about LBP to consumers. A recent cluster randomised trial [19] demonstrated that a pharmacy-initiated multidisciplinary intervention was feasible and effective in delivering positive patient outcomes for people with osteoarthritis. However, currently there is a gap in understanding the role of primary care portals such as community pharmacies, in contributing to the management of chronic conditions such as LBP.…”