title: Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials.
abstract: BACKGROUND
  Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care.
  
  
  METHODS
  One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed.
  
  
  CONCLUSIONS
  Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings.
  
  
  BACKGROUND
  NCT01130740 (VA); NCT 01435109 (NIH).
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA. Kelli.Allen@Duke.edu
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Dorothea S
authors.initials: DS
authors.lastname: Brock
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Chapman
authors.forename: Ranee
authors.initials: R
authors.lastname: Chatterjee
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Karen A
authors.initials: KA
authors.lastname: Juntilla
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kruszewski
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Marbrey
authors.forename: Jennifer
authors.initials: J
authors.lastname: McDuffie
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Nina
authors.initials: N
authors.lastname: Sperber
authors.forename: Mary P
authors.initials: MP
authors.lastname: Sochacki
authors.forename: Catherine
authors.initials: C
authors.lastname: Stanwyck
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Strauss
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
mesh_terms: D001175:Arthrography; D002985:Clinical Protocols; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009043:Motor Activity; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D059408:Pain Management; D011320:Primary Health Care; D020127:Recovery of Function; D012107:Research Design; D016896:Treatment Outcome; D058014:Veterans Health; D061217:Weight Reduction Programs