Introduction of clinical guidelines for the diagnosis and treatment of osteoarthrosis: results of a cluster randomized trial

Objective: to evaluate the impact of the active introduction of clinical guidelines for the diagnosis and treatment of osteoarthrosis (OA) by primary care physicians on the efficiency of performed therapy and patient adherence to treatment. Methods. This was an open pragmatic cluster randomized controlled trial covering 16 general practitioners who completed the trial and 92 patients clinically diagnosed as having knee and/or hip OA (63 in the intervention group and 29 in the control group). The intervention involved a one-day didactic educational seminar for the physicians, printed guideline materials, and patient brochures. The control group physicians received no additional information support. WOMAC pain and stiffness scores, body mass index (BMI), adherence to treatment (nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic exercises, alternative treatments) at 6 and 12 months after the intervention were taken into account when evaluating therapeutic effectiveness. Results. In the intervention group, the mean WOMAC pain scores were 6.9 and 13.3 points lower than in the controls at 6 (p = 0.16) and 12 (p = 0.017) months, respectively. The mean WOMAC stiffness scores in the intervention group were 6.7 and 14.7 points lower than in the controls at 6 (p = 0.29) and 12 (p = 0.039) months, respectively. The proportion of the patients using an alternative treatment dramatically decreased in the intervention group by 23 and 33% at 6 (p = 0.044) and 12 (p = 0.024) months, respectively. In the intervention group, the change in other parameters was less conclusive: by the end of the year, BMI slightly decreased (-1 kg/m 2; p = 0.95); the regular usage of NSAID reduced by 3% at 6 month (p = 0.7) and then increased by 10% at 12 month (p = 0.21). Adherence to regular physical exercises in the intervention group was 13 and 9% higher than in the controls at 6 (p = 0.23) and 12 (p = 0.42) months, respectively. Conclusion. The introduction of the clinical guidelines for the diagnosis and treatment of osteoporosis by means of a didactic educational seminar in combination with the printed methodical materials and patient brochures being given to physicians may optimize treatment and improve patient outcomes, but trials involving a larger sample are needed to confirm this effect.

osteoarthritis, clinical guidelines, cluster randomized trial

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