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Randomized Controlled Trial
. 2012 Feb;44(2):65-72.
doi: 10.1016/j.aprim.2011.01.007. Epub 2011 Jun 8.

Can an intervention on clinical inertia have an impact on the perception of pain, functionality and quality of life in patients with hip and/or knee osteoarthritis? Results from a cluster randomised trial

Alejandro Tejedor Varillas  1 , Fernando León Vázquez, David Lora Pablos, Alvaro Pérez Martín, Francisco Vargas Negrín, Agustín Gómez de la Cámara; ArtroPro Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Can an intervention on clinical inertia have an impact on the perception of pain, functionality and quality of life in patients with hip and/or knee osteoarthritis? Results from a cluster randomised trial

Alejandro Tejedor Varillas et al. Aten Primaria. 2012 Feb.

Abstract
in English, Spanish

Objectives: Evaluate whether an intervention applied to general practitioners to prevent clinical inertia had an impact on pain, functionality, and health-related quality of life (HRQoL) of patients with hip and/or knee osteoarthritis.

Design: This was a cluster-based, multicentre, prospective, randomized, parallel-group study. Clusters of physicians working were assigned to one of two study groups. Physicians in Group 1 received a training session while those in Group 2 did not.

Setting: Primary Care Health centers representative of the entire Spanish territory.

Participants: 329 general practitioners of primary healthcare centre.

Interventions: The intervention consists of a motivational session to propose a proactive care, based on current recommendations.

Measurements: Visual analogue scale (VAS); functionality (WOMAC scale) and global perception of health by SF-12. Effects were measured in two visits six months apart.

Results: A total of 1361 physicians, and 4076 patients participated in the study. No significant differences were observed in the clinical benefit obtained between patients assigned to Group 1 and Group 2. Nevertheless, a significant improvement was observed in the combined population (Groups 1 + 2) in the VAS (p<0.001), WOMAC (p<0.0001) and SF-12v2 (p<0.001) questionnaires in Visit 2 compared to Visit 1.

Conclusions: The results indicate that, although this specific intervention carried out on physicians did not provide an additional clinical benefit to patients with knee and/or hip osteoarthritis, an increased awareness of the patient's disease through the use of functionality indexes, as well as the mere fact of being observed, seem to improve patient-reported pain, functionality and HRQoL.

Objetivos: Evaluar si una intervención aplicada a médicos de familia para evitar la inercia clínica tuvo un impacto en el dolor, funcionalidad y calidad de vida relacionada con la salud (CVRS) de los pacientes con artritis de cadera y/o rodilla.

Diseño: Estudio de grupos paralelos de cluster, multicéntrico, prospectivo, aleatorizado. Los médicos fueron asignados a 2 grupos, el grupo 1 recibieó una sesión de entrenamiento, el grupo 2, no.

Emplazamiento: Centros de salud representativos del territorio español.

Participantes: Médicos de familia de 329 centros de salud.

Intervenciones: Consistieron en una sesión motivadora para proponer una atención proactiva, basada en recomendaciones actualizadas.

Mediciones principales: Escala analógica visual (EVA); funcionalidad (escala WOMAC) y percepción global de salud mediante SF-12 en 2 visitas separadas por 6 meses.

Resultados: Participaron 1.361 médicos y 4.076 pacientes. No se observaron diferencias significativas en el beneficio clínico obtenido entre los pacientes asignados al grupo 1 y grupo 2. Sin embargo, se observó una mejora significativa en la población total (grupos 1 + 2) en la EVA (p < 0,001), WOMAC (p < 0,0001) y el SF-12V2 (p < 0,001) en la visita 2 en comparación con la visita 1.

Conclusiones: Esta intervención sobre médicos de familia no proporcionó un beneficio clínico adicional a los pacientes. Se observó en ambos grupos una mayor conciencia de la enfermedad del paciente por el uso novedoso de índices de funcionalidad y CVRS, que parece mejorar el dolor percibido, la funcionalidad y la calidad de vida relacionada con la salud.

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Figures

None
General scheme of the study: Distribution of patients according to study groups and visits. Group 1, General Practioners who received a training session and Group 2 which did not receive one. Visit 1, first visit to the Family Doactor clinic, and Visit 2 six months later.
See this image and copyright information in PMC

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