Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide

Søren T Skou, Ewa M Roos, Søren T Skou, Ewa M Roos

Abstract

Background: The uptake of evidence-based guidelines in clinical practice is suboptimal in osteoarthritis (OA) and other chronic diseases. Good Life with osteoArthritis in Denmark (GLA:D) was launched in 2013 with the aim of implementing guidelines for the treatment of knee and hip OA in clinical care nationwide. The purpose of this report was to evaluate the effects of the GLA:D intervention from 2013 to 2015, using data from the national GLA:D registry.

Methods: Patients undergo education and supervised exercise delivered by trained physiotherapists. Outcomes evaluated at baseline, 3 and 12 months are pain intensity (0 to 100, best to worst), objective physical function (30-s chair-stand test and 40-m fast-paced walk test), physical activity (number of days per week being physically active for at least 30 min), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) quality of life subscale, 0-100, worst to best), number of patients on painkillers and sick leave, and access to care according to guidelines.

Results: Data from 9,825 participants from the GLA:D registry were utilised in the analyses. It was demonstrated that GLA:D improved pain intensity and quality of life by 12.4 points and 5.4 points at 3 months, and 13.7 points and 9.4 points at 12 months, respectively. Furthermore, physical function and physical activity improved (only at 3 months), fewer patients took painkillers following the treatment, and fewer patients were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D. GLA:D is offered in all five health care regions in Denmark via 286 active GLA:D units, but the uptake in the Danish municipalities is still low with only 20% of the municipalities offering GLA:D.

Conclusion: Three years after its inception, GLA:D has been rolled out nationwide and has a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave. The lifestyle changes introduced by education and supervised exercise were largely maintained at 1 year and may have the potential to also improve general health and reduce societal costs.

Keywords: Exercise therapy; Health education; Implementation; Osteoarthritis.

Figures

Fig. 1
Fig. 1
Flow diagram in Good Life with osteoArthritis in Denmark (GLA:D™). Minimal intervention involving education and supervised exercise are mandatory elements of the GLA:D treatment package
Fig. 2
Fig. 2
Pain intensity at baseline, 3 and 12 months in patients with knee and hip osteoarthritis participating in Good Life with osteoArthritis in Denmark (GLA:D™). Adjusted (baseline pain intensity, gender, age, and BMI) estimated marginal means from a mixed effects model (n = 3,402). Error bars indicate 95% confidence intervals. Pain intensity was significantly lower at 3 and 12 months compared with baseline (*; P < 0.001). VAS = Visual Analogue Scale
Fig. 3
Fig. 3
Joint-related quality of life (KOOS/HOOS QOL) at baseline, 3 and 12 months in patients with knee and hip osteoarthritis participating in Good Life with osteoArthritis in Denmark (GLA:D™). Adjusted (baseline KOOS/HOOS QOL, gender, age, and BMI) estimated marginal means from a mixed effects model (n = 3,405). Error bars indicate 95% confidence intervals. QOL was significantly higher at 3 and 12 months compared with baseline (*; P < 0.001) and at 12 months compared with 3 months (#; P < 0.001). KOOS = Knee injury and Osteoarthritis Outcome Score; HOOS = Hip disability and Osteoarthritis Outcome Score
Fig. 4
Fig. 4
Distribution of clinical units in Good Life with osteoArthritis in Denmark (GLA:D™). The GLA:D units across the five regions of Denmark, which had registered patients in the GLA:D registry, and the number of citizens of 16 years and above with self-reported osteoarthritis (OA) per GLA:D unit. Picture of Denmark has been modified from Jarke [45] licensed under the Creative Commons Attribution-Share Alike 2.5 Generic License

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