Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine &...
-
Upload
jeremy-hines -
Category
Documents
-
view
215 -
download
2
Transcript of Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine &...
![Page 1: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/1.jpg)
Optimizing care for patients with OA
111
Joost Dekker PhDDepartment of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center, Amsterdam, Netherlands
![Page 2: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/2.jpg)
Contents
• Current level of care
• Organizing care
• Developing and improving interventions
• Adherence to exercise and physical activity
2
![Page 3: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/3.jpg)
Level of care
• Lack of care– Patients with OA do not seek care– Patients with OA are discouraged to seek care
3
![Page 4: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/4.jpg)
![Page 5: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/5.jpg)
Level of care
• Lack of care– Patients with OA do not seek care– Patients with OA are discouraged to seek care
• Exercise therapy and physical activity – Lack of trust among GP, PT’s and patients
5
![Page 6: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/6.jpg)
![Page 7: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/7.jpg)
![Page 8: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/8.jpg)
8
Patients’ barriers
Holden et al, 2012
Dekker, 2012
![Page 9: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/9.jpg)
Level of care
• Lack of care– Patients with OA do not seek care– Patients with OA are discouraged to seek care
• Exercise therapy and physical activity – Lack of trust among GP, PT’s and patients
• Appropriateness of care– Total knee arthroplasty
9
![Page 10: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/10.jpg)
Criteria for the appropriateness of TKA
10Escobar et al, 2003
![Page 11: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/11.jpg)
Evaluation of the appropriateness of TKA
11
Riddle et al, 2014
![Page 12: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/12.jpg)
Level of care
• Lack of care– Patients with OA do not seek care– Patients with OA are discouraged to seek care
• Exercise therapy and physical activity – Lack of trust among GP, PT’s and patients
• Appropriateness of care– Total knee arthroplasty
12
![Page 13: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/13.jpg)
Contents
• Current level of care
• Organizing care
• Developing and improving interventions
• Adherence to exercise and physical activity
13
![Page 14: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/14.jpg)
Organizing care
• Range of professionals and interventions
– GP, orthopedic surgeon, rheumatologist, physiotherapist, dietician, multidisciplinary rehabilitation
– Pharmacological interventions– Surgical interventions– Exercise, physical activity– Education, life style advise– Intra-articular injections– Diet
14
![Page 15: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/15.jpg)
Stepped care
• BART Strategy - Beating osteoARThritis– Less intensive interventions are tried first– More intensive interventions reserved for those insufficiently
helped by the initial intervention
15
![Page 16: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/16.jpg)
16
![Page 17: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/17.jpg)
17
Results No statistically significant differences were found in changes over a 2-year period in pain and physical function between patients who received SCS-inconsistent care (n = 163) and patients who received SCS-consistent care (n = 117). Conclusion The results raised several important issues that need to be considered regarding the value of the SCS, such as the reasons that GPs provide SCS-inconsistent care, the long-term effects of the SCS, and the effects on costs and side effects.
![Page 18: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/18.jpg)
Contents
• Current level of care
• Organizing care
• Developing and improving interventions
• Adherence to exercise and physical activity
18
![Page 19: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/19.jpg)
Developing and improving interventions
• Exercise therapy
19
![Page 20: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/20.jpg)
Exercise therapy in knee OA
• Exercise is dominant intervention– Pain relieve– Improved performance of activities
• Exercise recommended in all major guidelines
20
![Page 21: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/21.jpg)
Exercise therapy in OA
• Effect size small to moderate– How to improve ?
• Therapy targeting risk factor for functional decline– Comorbidity
21
![Page 22: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/22.jpg)
22
OA does not come alone
• Comorbidity – High rate: 68 – 85%
• Wide range of comorbid diseases– Cardiac diseases, hypertension– Type 2 diabetes, obesity, – Chronic obstructive pulmonary diseases (COPD)– OA of the foot and hand– Chronic pain, low back pain– Depression– Visual or hearing impairments– Chronic cystitis– Stroke– Bowel disorders
![Page 23: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/23.jpg)
Comorbidity and exercise
• Reduced intensity of exercise – Physical therapists– Patients
• Exercise therapy unlikely to be effective
• Need to adapt exercise to comorbidity
23
![Page 24: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/24.jpg)
24
Exercise adapted to comorbidity
![Page 25: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/25.jpg)
25
Exercise adapted to comorbidity
• ’I felt more confident in performing exercises and was less afraid to get hypoglycaemia during or after the training, because the therapist had more knowledge about my diseases and training possibilities. When I was treated <by my previous therapist>, … I was afraid … of becoming hypoglycaemic. Therefore I wasn’t really motivated to do my exercises’’.
• More evidence needed
de Rooij et al, 2014
![Page 26: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/26.jpg)
Contents
• Current level of care
• Organizing care
• Developing and improving interventions– Focus of KNEEMO
• Adherence to exercise and physical activity
26
![Page 27: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/27.jpg)
27
Adherence and outcome in OA
• Adherence to home exercises– 3 months: 58 %– 15 months: 44 %– 60 months: 30 %
• Adherence associated with better outcome– Pain, physical function
Pisters et al, 2010
![Page 28: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/28.jpg)
28
0
1
2
3
4
5
6
7
8
9
100 3 15 60
Chan
ge in
phy
sical
func
tion
(WO
MAC
)
Adherence
Non-adherence
Months
Adherence and outcome
Improvement
Pisters et al, 2010
![Page 29: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/29.jpg)
29
Patients’ barriers
Holden et al, 2012
Dekker, 2012
![Page 30: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/30.jpg)
30
Improving adherence
• Use professional body of knowledge
• Behavioral approaches
• Delivery of exercise
• Tailoring of exercise to phenotypes and comorbidity
• Web-based interventions, mobile phones
Jordan et al, 2010
![Page 31: Optimizing care for patients with OA 111 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center,](https://reader035.fdocuments.us/reader035/viewer/2022062715/56649d765503460f94a58211/html5/thumbnails/31.jpg)
Summary
• Current level of care– Not adequate
• Organizing care
• Developing and improving interventions– Focus of KNEEMO
• Adherence to exercise and physical activity
• Other options to improve care for patients with OA
31