title: Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review.
abstract: The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care.
  
  
  
  A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015.
  
  
  
  The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most promise used educational interventions delivered by GPs with reinforcement by practice nurses.
  
  
  
  There are currently very few studies that target multidisciplinary approaches suitable for OA across multiple joint sites, in primary care. A more consistent approach to outcome measurement in future studies of this nature should be considered to allow for better comparison.
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK. a.finney@keele.ac.uk.
authors.forename: Andrew
authors.identifier: 0000-0001-7353-7480
authors.initials: A
authors.lastname: Finney
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Healey
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Jordan
authors.affiliation: Staffordshire Rheumatology Centre, The Haywood Hospital, Burslem, Stoke-on-Trent, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Krysia S
authors.initials: KS
authors.lastname: Dziedzic
mesh_terms: D022126:Access to Information; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics*; D006801:Humans; D010003:Osteoarthritis / Q000191:economics / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000191:economics*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D057566:Self Report; D016896:Treatment Outcome; D061217:Weight Reduction Programs / Q000191:economics*
keywords: Joint pain; Multidisciplinary; Multisite; Osteoarthritis