Numerous nonsurgical interventions have been reported to improve symptoms of knee
April 16, 2017
Numerous nonsurgical interventions have been reported to improve symptoms of knee osteoarthritis (OA) on the short term. utilization through 2 years follow-up. = 336) or 2 years (= 217) follow-up. At each follow-up main outcomes included sign severity acquired using validated questionnaires current medication use previous procedures on the prospective knee and health power scores. Cost power scores for the knee OA treatment program were determined and compared to standard cost effectiveness benchmarks. Patients Eligible patients were adults with symptomatic knee OA who unsuccessfully exhausted traditional nonsurgical therapies. Patients were enrolled at 27 OsteoArthritis Centers of AmericaSM treatment centers in six says in the US. All patients provided informed consent before study participation. Institutional review board approval was not required because patient data used for the cost-effectiveness analysis was de-identified existing data. The research complied with the principles of the Declaration of Helsinki. Pre-treatment assessments At the treatment centers baseline assessments included a clinical and orthopedic examination. Standing weight-bearing X-rays were taken and knee OA disease severity was classified using the Kellgren-Lawrence (K-L) grading scale.17 Patients with a K-L grade between 1 and 4 were eligible to participate. A diagnostic arthrogram was performed to rule out contraindications to program participation (eg symptomatic meniscal tear significant ligamentous instability) to confirm the absence of large osteophytes that may potentially interfere with tri-compartmental HA flow and GR 38032F to make sure the structural integrity of the joint capsule at the HA injection site. Knee OA treatment GF1 program The 8-week multimodal knee OA treatment program has been described in detail elsewhere.16 Briefly the program includes weekly HA injections for 3 to 5 5 weeks (depending on the viscosupplement) delivered under fluoroscopic guidance. The use of fluoroscopy allows confirmation of tri-compartmental HA flow and improves GR 38032F injection accuracy resulting in superior patient outcomes compared to anatomical injection guidance.18 Patients participated in a GR 38032F deliberate physical therapy rehabilitation and education program provided by licensed physical therapists two to three times per week. Knee bracing was prescribed when clinically indicated in order to unload the affected joint. At program discharge patients were encouraged to continue participation in regular low-impact aerobic activity and functional exercises at home. Long-term follow-up A total of 1 1 235 patients who previously completed a single 8-week treatment course and were 1 or GR 38032F 2 2 years (±1 month) since program initiation were randomly selected to participate in the long-term follow-up phase of this study. Patients who participated in two or more 8-week treatment courses were not eligible for the study. Interviewers participated in pilot testing to refine the telephone-based questionnaire and were trained to ensure a consistent structure among interviewers and study sites. Telephone interviews took approximately 15 minutes and were administered between November 2013 and April 2014. Main outcomes Knee pain severity using a 0 to 10 scale and WOMAC version 3.119 were collected before and after the 8-week program. All WOMAC scores were normalized to a 0 to 100 scale with a higher score representing a worse outcome. In the long-term follow-up phase of the study main outcomes included current medication use previous operations on the target GR 38032F knee and utility scores from the EQ-5D questionnaire. The EQ-5D provides a single index value for health status and is comprised of five dimensions including mobility self-care usual activities pain/pain and stress/depressive disorder.20 The response to each EQ-5D dimension identifies a unique health state which is converted to a weighted health state index using population norms. Since the EQ-5D was not administered pre-treatment power scores were derived from pre-treatment WOMAC scores in order to facilitate cost effectiveness calculations.21 The power of the knee OA treatment program was quantified using the quality-adjusted life 12 months (QALY) metric which determines the quantity and quality of life gained by an intervention.22 23 One QALY represents 1 year in perfect health a score of 0 QALYs represents either death or 1 year in a coma and negative values may be used to represent severe.