Background/Purpose

In 2008, a multidisciplinary osteoarthritis (MOA) clinic was established at St. Michael’s Hospital (SMH), a tertiary care academic teaching facility, serving a diverse social, economic and cultural urban population in Toronto. The team (Rheumatologist, Advanced Practice Physiotherapists) designs a comprehensive treatment plan which consists of one or more of the following:

• patient education    
• weight loss strategies which may include a referral to a dietition and possible  bariatric surgery
• an exercise program
•  prescription for an unloader brace, orthotics  or wedges                 
• intrarticular corticosteroid or hyaluronic acid injection
• discussion about referral for joint replacement surgery

All patients complete two questionnaires at each visit: 

1)    Multi-Dimensional Health Assessment Questionnaire  (MDHAQ)

2)    Western Ontario and McMaster Universities Arthritis Index (WOMAC).

The purpose of this continuous qualitative improvement project is to evaluate the outcomes of patients who attend the OA clinic.  The research question is:  How much change occurs in a patient’s functional scores from the initial assessment to the three month follow up visit after a treatment intervention has occurred?

Methods

This study is a retrospective observational cohort. Patients with knee, hip, or other joint OA visiting the OA clinic from January 2009 to Dec 2011 were included in the study. Patients visiting for other reasons such as rheumatoid arthritis or bursitis were not included in analysis. A chart review of patients with baseline information and 3-month follow-up (+/- 3 weeks) were used for analysis, which includes WOMAC and MDHAQ questionnaires for both visits. Subsequent visits are on “as needed” basis, although data from those visits are still recorded and used in some of the analysis. Unfortunately, given the nature of the population and the study, no control population was available

Results

• Most patients attended the clinic for symptomatic knee OA. 
• Approximately 1/3 of the patients were recommended for surgery consult.

There was baseline and follow-up data that was analyzed for patients with knee OA (group 1) and a subset (group 2) with moderate to severe baseline pain. 

Group 1: statistically significant improvements in function (WOMAC p = 0.0061) and fatigue (MDHAQ p = 0.0372) but not pain (WOMAC p = 0.656 and MDHAQ p= 0.3137) were observed.          

Group 2: the results were similar, with the exception of the change in pain, which was statistically significant as measured by the MDHAQ (p = 0.0004) but not the WOMAC (p= 0.5059).  

A change in WOMAC stiffness was higher for group 2 (p = 0.07), but the change in duration of stiffness was similar in both groups (p = 0.0513 and p= 0.0608)

Other trends observed were:

(i) Patients with a knee effusion tended to respond better to cortisone injections,

(ii) Patients less than 40 years old respond better to treatment          

(iii) Patients with neutral knee alignment did better.

Conclusion

These results reflect actual clinical situations, and validate a multidisciplinary approach to OA management.   The results support a multidisciplinary approach utilizing a coordinated assessment by both rheumatologist and advanced physiotherapy practitioners in a one stop shop model to substantially improve overall OA management

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-osteoarthritis-outcomes-utilizing-a-multidisciplinary-model-of-care-experience-in-a-diverse-multicultural-urban-teaching-hospital/