Quality indicators indicate good adherence to the clinical practice guideline on "Osteoarthritis of the hip and knee" and few prognostic factors influence outcome indicators: a prospective cohort study.

Abstract

BACKGROUND: Evaluation with quality indicators of adherence to the clinical practice guideline on "Osteoarthritis of the hip and knee" and of treatment outcomes. AIM: Furthermore to determine prognostic factors for outcome indicators. DESIGN: Prospective cohort study. POPULATION: Twenty-seven well informed physical therapists recorded patient and treatment characteristics of 103 community-dwelling patients referred by a general practitioner diagnosed with osteoarthritis of hip or knee. METHODS: With selected process and outcome indicators adherences to the guideline and treatment outcomes were assessed. Prognostic factors were calculated for Algofunctional Index (AI) and Visual Analogue Scale (VAS) for pain (decreases of </=25% indicating "poor outcome"), number of sessions (>12) and duration of treatment (>6 weeks), using multivariate logistic regression models. RESULTS: Process indicators showed that information & advice was given to 95% of the patients and functions and activities were exercised in 97% respectively 87%. Aftercare was arranged for 46% of the patients, that was clearly lower than the benchmark of 90%. Outcome indicators VAS-pain and AI decreased by 45% and 36%, respectively. The combination ">12 months" duration of complaints and age >/=65" was associated with a "poor outcome" on AI (OR 2.53; 95% CI 1.01-6.38). Co-morbidity (OR 2.8; 95% CI 1.17-6.88), and "VAS-pain at baseline >/=51 mm" (OR 3.1; 95% CI 1.34-7.23) were associated with a higher number of treatment sessions. CONCLUSION AND CLINICAL REHABILITATION IMPACT: and Quality indicators showed that a group of well-informed physical therapists could to a large extent adhere to key recommendations of the guideline and that clinically relevant improvements were obtained in terms of pain and physical functioning. Prognostic factors for poorer outcome on outcome indicators were comorbidity, a higher pain score at baseline and the combination ">12 months' duration of complaints and age >/=65".