title: Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.
abstract: BACKGROUND
  A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.
  
  
  OBJECTIVE
  To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes.
  
  
  METHODS
  Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109).
  
  
  METHODS
  10 Duke University Health System community-based primary care clinics.
  
  
  METHODS
  537 outpatients with symptomatic hip or knee osteoarthritis.
  
  
  METHODS
  The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers.
  
  
  METHODS
  The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups.
  
  
  RESULTS
  No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care.
  
  
  CONCLUSIONS
  The study involved 1 health care network. Data on provider referrals were not collected.
  
  
  CONCLUSIONS
  Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care.
  
  
  BACKGROUND
  National Institute of Arthritis and Musculoskeletal and Skin Diseases.
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ranee
authors.initials: R
authors.lastname: Chatterjee
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McDuffie
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Strauss
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Leonor
authors.initials: L
authors.lastname: Corsino
authors.affiliation: From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
mesh_terms: D015992:Body Mass Index; D059350:Chronic Pain / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D059408:Pain Management; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome; D015431:Weight Loss