Rheumatology International

, Volume 33, Issue 7, pp 1821–1828 | Cite as

An innovative care model coordinated by a physical therapist and nurse practitioner for osteoarthritis of the hip and knee in specialist care: a prospective study

  • Veronique M. A. Voorn
  • Henricus M. Vermeulen
  • Rob G. H. H. Nelissen
  • Margreet Kloppenburg
  • Tom W. J. Huizinga
  • Nicolette A. C. Leijerzapf
  • Herman M. Kroon
  • Thea P. M. Vliet Vlieland
  • Henrica M. J. van der Linden
Original Article


The subject of the study is to investigate whether health-related quality of life (HRQoL), pain and function of patients with hip or knee osteoarthritis (OA) improves after a specialist care intervention coordinated by a physical therapist and a nurse practitioner (NP) and to assess satisfaction with this care at 12 weeks. This observational study included all consecutive patients with hip or knee OA referred to an outpatient orthopaedics clinic. The intervention consisted of a single, standardized visit (assessment and individually tailored management advice, to be executed in primary care) and a telephone follow-up, coordinated by a physical therapist and a NP, in cooperation with an orthopaedic surgeon. Assessments at baseline and 10 weeks thereafter included the short form-36 (SF-36), EuroQol 5D (EQ-5D), hip or knee disability and osteoarthritis outcome score (HOOS or KOOS), the intermittent and constant osteoarthritis pain questionnaire (ICOAP) for hip or knee and a multidimensional satisfaction questionnaire (23 items; 4 point scale). Eighty-seven patients (57 female), mean age 68 years (SD 10.9) were included, with follow-up data available in 63 patients (72 %). Statistically significant improvements were seen regarding the SF-36 physical summary component score, the EQ-5D, the ICOAP scores for hip and knee, the HOOS subscale sports and the KOOS subscales pain, symptoms and activities of daily living. The proportions of patients reporting to be satisfied ranged from 79 to 98 % per item. In patients with hip and knee OA pain, function and HRQoL improved significantly after a single-visit multidisciplinary OA management intervention in specialist care, with high patient satisfaction.


Osteoarthritis Quality of life Satisfaction Patient centred care Physical therapy modalities 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Peat G, McCarney R, Croft P (2001) Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis 60:91–97PubMedCrossRefGoogle Scholar
  2. 2.
    Zhang W, Moskowitz RW, Nuki G et al (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16:137–162PubMedCrossRefGoogle Scholar
  3. 3.
    Zhang W, Doherty M, Peat G et al (2010) EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 69:483–489PubMedCrossRefGoogle Scholar
  4. 4.
    Zhang W, Doherty M, Arden N et al (2005) EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis 64:669–681PubMedCrossRefGoogle Scholar
  5. 5.
    Peter WFH, Jansen MJ, Hurkmans EJ et al (2011) Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port 36:268–281PubMedGoogle Scholar
  6. 6.
    Dutch Orthopaedic Association (2007) CBO guideline OA hip and knee (ref type: online source)Google Scholar
  7. 7.
    Dieppe P, Brandt KD (2003) What is important in treating osteoarthritis? Whom should we treat and how should we treat them? Rheum Dis Clin N Am 29:687–716CrossRefGoogle Scholar
  8. 8.
    Moe RH, Uhlig T, Kjeken I, Hagen KB, Kvien TK, Grotle M (2010) Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial. BMC Musculoskelet Disord 11:253PubMedCrossRefGoogle Scholar
  9. 9.
    Brand CA, Amatya B, Gordon B, Tosti T, Gorelik A (2010) Redesigning care for chronic conditions: improving hospital-based ambulatory care for people with osteoarthritis of the hip and knee. Intern Med J 40:427–436PubMedCrossRefGoogle Scholar
  10. 10.
    Jordan KM, Arden NK, Doherty M et al (2003) EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT). Ann Rheum Dis 62:1145–1155PubMedCrossRefGoogle Scholar
  11. 11.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRefGoogle Scholar
  12. 12.
    WHO Scientific Group (1992) Rheumatic diseases. World Health Organ Tech Rep Ser 816:1–59Google Scholar
  13. 13.
    Aaronson NK, Muller M, Cohen PD et al (1998) Translation, validation, and norming of the Dutch language version of the SF-36 health survey in community and chronic disease populations. J Clin Epidemiol 51:1055–1068PubMedCrossRefGoogle Scholar
  14. 14.
    Ware JE, Snow KKM (2009) User’s manual for the SD-36v2 health survey. Advantages of norm based scoring, chap 7, pp 81–84Google Scholar
  15. 15.
    Cheung C, Oemar O, Oppe M, Rabin R (2010) User guide, basic information on how to use EQ-5DGoogle Scholar
  16. 16.
    Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, van Busschbach JJ (2005) Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskd 149:1574–1578PubMedGoogle Scholar
  17. 17.
    Hawker GA, Davis AM, French MR et al (2008) Development and preliminary psychometric testing of a new OA pain measure—an OARSI/OMERACT initiative. Osteoarthr Cartil 16:409–414PubMedCrossRefGoogle Scholar
  18. 18.
    Maillefert JF, Kloppenburg M, Fernandes L et al (2009) Multi-language translation and cross-cultural adaptation of the OARSI/OMERACT measure of intermittent and constant osteoarthritis pain (ICOAP). Osteoarthr Cartil 17:1293–1296PubMedCrossRefGoogle Scholar
  19. 19.
    Klassbo M, Larsson E (2003) Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities osteoarthritis index. Scand J Rheumatol 32:46–51PubMedCrossRefGoogle Scholar
  20. 20.
    de Groot IB, Reijman M, Terwee CB et al (2007) Validation of the Dutch version of the hip disability and osteoarthritis outcome score. Osteoarthr Cartil 15:104–109PubMedCrossRefGoogle Scholar
  21. 21.
    de Groot IB, Favejee MM, Reijman M, Verhaar JA, Terwee CB (2008) The Dutch version of the knee injury and osteoarthritis outcome score: a validation study. Health Qual Life Outcomes 6:16PubMedCrossRefGoogle Scholar
  22. 22.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedGoogle Scholar
  23. 23.
    Tijhuis GJ, Kooiman KG, Zwinderman AH, Hazes JM, Breedveld FC, Vliet Vlieland TP (2003) Validation of a novel satisfaction questionnaire for patients with rheumatoid arthritis receiving outpatient clinical nurse specialist care, inpatient care, or day patient team care. Arthritis Rheum 49:193–199PubMedCrossRefGoogle Scholar
  24. 24.
    Halbert J, Crotty M, Weller D, Ahern M, Silagy C (2001) Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms. Arthritis Rheum 45:228–234PubMedCrossRefGoogle Scholar
  25. 25.
    Victor CR, Triggs E, Ross F, Lord J, Axford JS (2005) Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee. Clin Rheumatol 24:358–364PubMedCrossRefGoogle Scholar
  26. 26.
    Wetzels R, Van Weel C, Grol R, Wensing M (2008) Family practice nurses supporting self-management in older patients with mild osteoarthritis: a randomized trial. BMC Fam Pract 9:7PubMedCrossRefGoogle Scholar
  27. 27.
    van den Hout WB, Tijhuis GJ, Hazes JM, Breedveld FC, Vliet Vlieland TP (2003) Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care. Ann Rheum Dis 62:308–315PubMedCrossRefGoogle Scholar
  28. 28.
    Mazzuca SA, Brandt KD, Katz BP, Ragozzino LR, G’sell PM (1997) Can a nurse-directed intervention reduce the exposure of patients with knee osteoarthritis to nonsteroidal antiinflammatory drugs? J Clin Rheumatol 10:315–322CrossRefGoogle Scholar
  29. 29.
    Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J (2007) Case management of arthritis patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum 57:1390–1397PubMedCrossRefGoogle Scholar
  30. 30.
    Mazzuca SA, Brandt KD, Katz BP, Chambers M, Byrd D, Hanna M (1997) Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Arthritis Rheum 40:1466–1474PubMedCrossRefGoogle Scholar
  31. 31.
    Heuts PH, de Bie R, Drietelaar M et al (2005) Self-management in osteoarthritis of hip or knee: a randomized clinical trial in a primary healthcare setting. J Rheumatol 32:543–549PubMedGoogle Scholar
  32. 32.
    Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J (2008) Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord 9:117PubMedCrossRefGoogle Scholar
  33. 33.
    Broadbent J, Maisey S, Holland R, Steel N (2008) Recorded quality of primary care for osteoarthritis: an observational study. Br J Gen Pract 58:839–843PubMedCrossRefGoogle Scholar
  34. 34.
    Snijders GF, den Broeder AA, van Riel PL et al (2011) Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol 40:225–231PubMedCrossRefGoogle Scholar
  35. 35.
    Gossec L, Paternotte S, Maillefert JF et al (2011) The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. Report of the OARSI–OMERACT task force on total joint replacement. Osteoarthr Cartil 19:147–154PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Veronique M. A. Voorn
    • 1
  • Henricus M. Vermeulen
    • 2
  • Rob G. H. H. Nelissen
    • 3
  • Margreet Kloppenburg
    • 4
  • Tom W. J. Huizinga
    • 4
  • Nicolette A. C. Leijerzapf
    • 3
  • Herman M. Kroon
    • 5
  • Thea P. M. Vliet Vlieland
    • 3
  • Henrica M. J. van der Linden
    • 3
  1. 1.Department of Medical Decision MakingLeiden University Medical CentreLeidenThe Netherlands
  2. 2.Department of Physical TherapyLeiden University Medical CentreLeidenThe Netherlands
  3. 3.Department of OrthopaedicsLeiden University Medical CentreLeidenThe Netherlands
  4. 4.Department of RheumatologyLeiden University Medical CentreLeidenThe Netherlands
  5. 5.Department of RadiologyLeiden University Medical CentreLeidenThe Netherlands

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