Stratified care in knee osteoarthritis: a pilot study to explore feasability and outcome of tailored interventions in primary care (WC2016-030)

Background

Starting date: 01/01/2016

Background

Exercise therapy is considered a key intervention in conservative knee OA management in order to reduce knee pain and activity limitations and to postpone knee joint replacement as long as possible. Exercise therapy (combined with patient education) has been found to be effective in reducing pain and activity limitations. However, effect sizes are moderate at best and need to be optimized. Because the knee OA population is highly heterogeneous, interventions need to be tailored to specific homogeneous subgroups of knee OA patients to optimize overall effectiveness and efficiency of knee OA management. Therefore, there is an urgent need for identifying clinically relevant subgroups and tailoring interventions to these subgroups.

Recently, we were the first to identify five clinically relevant subgroups of knee OA patients based on easily available patient characteristics (quadriceps muscle strength, depressive mood, body mass index (BMI) and radiographic severity of OA), and replicated this finding in a different cohort as well. For each of these subgroups, a specifically tailored intervention is likely to be more beneficial and cost-effective compared to usual ‘non-tailored’ care. We hypothesize that a protocol of stratified, conservative care, in which interventions are specifically tailored to each of the five identified subgroups of knee OA patients, will be feasible (tested in the current pilot-study) and (cost-)effective (planned to be tested in subsequent randomized controlled trial with usual care as comparison) in primary care.