title: Effectiveness of an Integrated Multidisciplinary Osteoarthritis Outpatient Program versus Outpatient Clinic as Usual: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Osteoarthritis (OA) is one of the leading causes of pain and disability. Given the constraint in the provision of care, there is a need to develop and assess effectiveness of new treatment models. The objective was to compare satisfaction with and effectiveness of a new integrated multidisciplinary outpatient program with usual care in an outpatient clinic for patients with OA.
  
  
  METHODS
  Patients with clinical OA referred to a rheumatology outpatient clinic were randomized to a 3.5-h multidisciplinary group-based educational program followed by individual consultations, or to usual care. The primary outcome was satisfaction with the health service evaluated on a numerical rating scale (0 = extremely unsatisfied, 10 = extremely satisfied) after 4 months. Secondary outcomes included health-related quality of life measures.
  
  
  RESULTS
  Of 391 patients, 86.4% (n = 338) were women, and mean age was 61.2 (SD 8.0) years. At 4 months, patients who received integrated multidisciplinary care were significantly more satisfied with the health service compared with controls, with a mean difference of -1.05 (95% CI -1.68 to -0.43, p < 0.001). Among secondary outcomes, only self-efficacy with other symptoms scale (10-100) improved significantly in the multidisciplinary group compared with controls at 4 months (3.59, 95% CI 0.69-6.5, p = 0.02). At 12 months, the Australian/Canadian Hand Osteoarthritis Index pain (0-10) and fatigue scores (0-10) were slightly worse in the multidisciplinary group with differences of 0.38 (95% CI 0.06-0.71, p = 0.02) and 0.55 (95% CI 0.02-1.07, p = 0.04), respectively.
  
  
  CONCLUSIONS
  Patients receiving an integrated multidisciplinary care model were more satisfied with healthcare than those receiving usual care, whereas there were no clinically relevant improvements in health outcomes.
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital. rikmoe@gmail.com.
authors.forename: Rikke Helene
authors.initials: RH
authors.lastname: Moe
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Margreth
authors.initials: M
authors.lastname: Grotle
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Kjeken
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Inge Christoffer
authors.initials: IC
authors.lastname: Olsen
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Petter
authors.initials: P
authors.lastname: Mowinckel
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Espen A
authors.initials: EA
authors.lastname: Haavardsholm
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Kåre Birger
authors.initials: KB
authors.lastname: Hagen
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.
authors.forename: Till
authors.initials: T
authors.lastname: Uhlig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000628:therapy*; D010045:Outpatients; D010348:Patient Care Team; D017060:Patient Satisfaction; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: EDUCATION; INTERDISCIPLINARY; MULTIDISCIPLINARY; OSTEOARTHRITIS; SATISFACTION