GLA:D

Research Unit for Musculoskeletal
Function and Physiotherapy (FOF)
Good Life with Arthritis in Denmark (GLA:D)
- Education and exercise in clinical practice
Søren Thorgaard Skou
Research Physiotherapist, PhD-student
GLAiD.dk
2
Recommendations for treatment of OA
 National and international guidelines for knee and hip OA
recommends patient education, exercise and weight loss (if needed)
as first line treatment
Fernandes et al. 2013; McAlindon et al. 2014; SST 2012; Roos et al. 2012
3
Implementation is missing, but needed!
 Clinical practice does not reflect the guidelines
 As little as 10 % receives rehabilitation 5 years prior to arthroplasty
DeHaan et al. 2007; Snijders et al. 2011; Runciman et al. 2012; Dhawan et al. 2014
4
To change clinical practice and implement
evidence you have to “…involve the relevant people;
develop a proposal for change that is evidence based, feasible,
and attractive; study the main difficulties in achieving the
change, and select a set of strategies and measures at
different levels linked to that problem”
In OA =
5
From evidence to clinical practice in Denmark
Aims
 Equal access to care according to clinical guidelines across
health care sectors and geographic regions
 Reduced number of visits and health care cost for the
individual and the society
 And for OA patients:
 Pain reduction
 Reduced intake of pain killers
 Improved physical function and physical activity
 Improved quality of life
What is GLA:D 1:
2-day course for physiotherapists at SDU
What is GLA:D 2:
8-weeks of education and supervised
neuromuscular exercise for patients
+
What is GLA:D 3:
Evaluation and registration in the GLA:Dregistry
 The patients are evaluated
on pain, function, quality of
life etc.
 Before starting, and after 3
and 12 months.
PREMIERE!
Preview
12
250
Before GLA:D (n>3.460)
TKA: 67.6 y and 60% women
THA: 68.5 y and 58% women
Number of patients
200
150
100
50
0
18 23 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90
Age
•Mean age 63.9 years
•75 % are women and 25 % are men
13
Before GLA:D (n>3.460)
100
90
80
Number of patients
70
60
50
40
30
20
10
Pain (VAS 0-100)
•Pain (VAS 0-100) before GLA:D:
•Hip OA (n>925):VAS 47; duration of pain of 45 mo
•Knee OA (n>2,500):VAS 48; duration of pain of 62 mo.
14
99
96
93
90
87
84
81
78
75
72
69
66
63
60
57
54
51
48
45
42
39
36
33
30
27
24
21
18
15
12
9
6
3
0
0
Reduction in pain (VAS 0-100)
Changes following GLA:D - Pain
0
-5
-10
-15
-20
-25
3mo - Before GLA:D
12mo - Before GLA:D
15
Hip (n=548/130)
-10,9
-14,4
Knee (n=1,471/294)
-14,4
-17,0
Changes following GLA:D – Other findings
(n>1,300/400)
 33 % had increased their level of physical activity after 3 months, 30 %
after 12 months, compared to before GLA:D
 35 % less were on sick leave after 12 months compared to before
GLA:D
 36 % less took pain killer due to their knee/hip after 3 months
compared to before GLA:D
 91 % of the patients were satisfied or very satisfied with GLA:D after
12 months and 80 % of the participants were still using what they
learned during GLA:D after 12 months on at least a weekly basis.
16
Results in GLA:D vs. BOA
 The effects from GLA:D on pain are
larger than BOA in Sweden, and at the
same time larger than what is
considered clinically relevant
 GLA:D>3,400 patients
 BOA>25,000 patients
In GLA:D 96 %
participates in the
supervised
neuromuscular
exercise.
 GLA:D is also effective in improving
function and reducing the intake of pain
killers among the patients
 GLA:D includes neuromuscular
exercise
 In BOA exercise is optional, and the
type of exercise is also optional
In BOA approx.
80% get a
unspecified
exercise program
and only 63-81% of
these participate in
supervised
exercise.
Tubach et al. 2012
GLA:D-vision 2017
I dag
 400 physiotherapists have been on the GLA:D-course
4,591 Patients in GLA:D
2,626 at 3months
676 at 12 months
 7000 patients have paticipated in GLA:D and are registered in
the GLA:D-registry
221 GLA:D-units and
418 physiotherapists
Foto Jakob Carlsen, Gigtforeningen.
Thank you for your attention!
Questions?
Søren Thorgaard Skou
[email protected]
www.glaid.dk
Next available GLA:D-course: 18th-19th of August 2015
19