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. 2022 May 26;23(1):498.
doi: 10.1186/s12891-022-05414-6.

Factors associated with physician-reported treatment status of patients with osteoarthritis pain

Thomas J Schnitzer  1 , Rebecca L Robinson  2 , Leslie Tive  3 , Joseph C Cappelleri  4 , Andrew G Bushmakin  4 , James Jackson  5 , Mia Berry  5 , Sophie Barlow  5 , Chloe Walker  5 , Lars Viktrup  6
Affiliations

Factors associated with physician-reported treatment status of patients with osteoarthritis pain

Thomas J Schnitzer et al. BMC Musculoskelet Disord. .

Abstract

Background: Osteoarthritis (OA) is typically associated with pain, but many patients are not treated.

Methods: This point in time study explored factors associated with treatment status, using logistic regression of data from the Adelphi OA Disease Specific Programme conducted in the United States. Patients' treatment status was based on physician-reported, current: 1) prescription medication for OA vs. none; and 2) physician treatment (prescription medication and/or recommendation for specified nonpharmacologic treatment for OA [physical or occupational therapy, acupuncture, transcutaneous electrical nerve stimulation, or cognitive behavior therapy/psychotherapy]) vs. self-management (no prescription medication or specified nonpharmacologic treatment).

Results: The 841 patients (including 57.0% knee OA, 31.9% hip OA) reported mild (45.4%) or moderate or severe (54.6%) average pain intensity over the last week. The majority were prescribed medication and/or recommended specified nonpharmacologic treatment; 218 were not prescription-medicated and 122 were self-managed. Bivariate analyses showed less severe patient-reported pain intensity and physician-rated OA severity, fewer joints affected by OA, lower proportion of joints affected by knee OA, better health status, lower body mass index, and lower ratings for cardiovascular and gastrointestinal risks, for those not prescribed medication (vs. prescription-medicated). Multivariate analyses confirmed factors significantly (p < 0.05) associated with prescription medication included (odds ratio): physician-rated current moderate OA severity (vs. mild, 2.03), patient-reported moderate OA severity 6 months ago (vs. mild, 1.71), knee OA (vs. not, 1.81), physician-recommended (0.28) and patient-reported (0.43) over-the-counter medication use (vs. not), prior surgery for OA (vs. not, 0.37); uncertain income was also significant. Factors significantly (p < 0.05) associated with physician treatment included (odds ratio): physician-recommended nonpharmacologic therapy requiring no/minimal medical supervision (vs. not, 2.21), physician-rated current moderate OA severity (vs. mild, 2.04), patient-reported over-the-counter medication use (vs. not, 0.26); uncertain time since diagnosis was also significant. Patient-reported pain intensity and most demographic factors were not significant in either model.

Conclusions: Approximately 1 in 4 patients were not prescribed medication and 1 in 7 were self-managed, although many were using over-the-counter medications or nonpharmacologic therapies requiring no/minimal medical supervision. Multiple factors were significantly associated with treatment status, including OA severity and over-the-counter medication, but not pain intensity or most demographics.

Keywords: Osteoarthritis; Pain; Prescription analgesic medication; Real-world clinical practice.

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Conflict of interest statement

TJS reports clinical research study support (Pfizer, Lilly, Regeneron, Galapagos, Taiwan Liposome Corporation, Anika Therapeutics) and fees for consultancy/advisory boards (Pfizer, Lilly, GSK, AstraZeneca, Galapagos, Merck). RLR and LV are employees and stockholders of Eli Lilly and Company. JJ, MB, SB, and CW are employees of Adelphi Real World, which received funding from Pfizer and Eli Lilly and Company to conduct the study. LT, AGB, and JCC are employees of Pfizer with stock and/or stock options.

Figures

Fig. 1
Fig. 1
Factors associated with current prescription of medication/s for OA (non-Rx compared with Rx). Multivariate logistic regression. Logarithmic scale. Factors significantly associated with current prescription of medication/s for OA, non-Rx vs. Rx, p < 0.05. Constant: odds ratio 0.96 (95% CI: 0.19, 4.83). Log pseudolikelihood = − 320.77. Number of observations = 745. Wald chi2(24) = 160.22, Prob > chi2 = 0.00, Pseudo R2 = 0.24. For data, see Supplementary Table 4. CI confidence interval, non-Rx not prescription-medicated, OA osteoarthritis, Rx prescription-medicated
Fig. 2
Fig. 2
Factors associated with self-management vs. physician treatment for OA. Multivariate logistic regression. Logarithmic scale. Factors significantly associated with self-management vs. physician treatment, p < 0.05. Physician treatment defined as current prescription of medication and/or physician recommendation/s for specified nonpharmacologic treatment for OA (physical or occupational therapy, acupuncture, transcutaneous electrical nerve stimulation, or cognitive behavior therapy/psychotherapy). Self-management defined as no prescription medication or specified nonpharmacologic treatment. Constant: odds ratio 0.51 (95% CI: 0.11, 2.30). Log pseudolikelihood = − 226.31. Number of observations = 751. Wald chi2(26) = 156.00, Prob > chi2 = 0.00, Pseudo R2 = 0.25. aNonpharmacologic therapy requiring no/minimal medical supervision (which were ineligible for the determination of treatment status). For data, see Supplementary Table 5. CI confidence interval, OA osteoarthritis
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