Non-pharmacological treatment in generalized osteoarthritis.

Rationale: An abundance of research literature illustrates that non-pharmacological treatment (NPT) is a useful treatment option in the management of hip or knee osteoarthritis (OA). To our knowledge however, only one study investigated the effect of NPT in the management of generalized osteoarthritis (GOA). This lack of research is a severe hiatus in current OA evidence. GOA-patients represent a substantial group of patients; it is estimated that 27% of patients with hip or knee OA also have GOA. Furthermore, the clinical picture of GOA is more complex than OA in a singular joint. Considering the latter, a comprehensive treatment programme focussing on the consequences of GOA on several aspects of health-related quality of life is warranted in this group of patients. In the literature several modes of delivery are proposed in the management of chronic diseases like arthritis.

We hypothesize that a multidisciplinary group-based, self-management intervention is more effective on functioning in daily living and more cost-efficient than the active control group in patients with generalized osteoarthritis (GOA).

Time points are: 6 weeks, 3, 6,9 and 12 months, 1 year after baseline and the average over 1 year after baseline.

Experimental intervention:

The intervention lasts 6 weeks (max 8 persons per group), consists of 7 meetings, and aims improve the patients health related quality of life by optimising the current lifestyle (i.e. physical activity and diet) and by enhancing the self-efficacy to control the disease (i.e. activity pacing, pain management and daily functioning). To enhance the patients’ self-efficacy we use the 5As model of behaviour change counselling, which is an evidence-based approach appropriate for a broad range of different behaviours and health conditions. The 5As are as follows: Assessing patient level of behaviour, beliefs and motivation; Advising the patient based upon personal health risks; Agreeing with the patient on a realistic set of goals; Assisting to anticipate barriers and develop a specific action plan; and Arranging follow-up support. An example, a participant wears a pedometer to elicit his/her physical activity level (A1). Together with the health care provider, the patient discusses the outcome (A2) and set a goal to increase the level of physical activity (A3). Both the health care provider and the patient must believe the goal is good (A3) and feasible (A4). Consequently, patient and therapist closely monitor the personal goals (A5). Adjacent to the self-management programme, patients are also enrolled in an exercise programme aimed to 1. improve the quality of movement and 2. implement the learned exercises in the home situation.



Active Control:

Patients enrolled in the telephone counselling group, attend two group sessions and are further monitored through telephone contact and self-monitoring. As per with the experimental intervention, the active control intervention aims to optimise the patients’ current lifestyle (i.e. physical activity and diet) and to enhance the patients’ self-efficacy to control the disease (i.e. activity pacing, pain management and daily functioning). Again, all patients set a personal goals. Progress on these personal goals will be monitored by the health care provider through planned telephone contact. Patients are asked to self-monitor their own health-status, by filling out activity and eating diaries and wearing pedometers.