Joint Health Program
Background: Osteoarthritis (OA) is a whole person problem that can substantially impact the physical, emotional, and social aspects of an individual’s health and wellbeing. However, few current models of orthopaedic care incorporate a comprehensive range of non-operative treatments to contend with an individual’s biopsychosocial needs or systematically assess the patient reported outcomes of these strategies over time.
Aim and relevance: Our aim in the JHP is to create a comprehensive, multi-modal, primary OA provider-led program to decrease fragmented care and systematically implement evidence-based recommendations.
The JHP Description: The JHP started in October 2017 with one physical therapist and 2 orthopaedic surgeons embedded in a major health care system. The program quickly received widespread support leading to significant growth throughout the health care system. Currently, the JHP includes 25 primary osteoarthritis providers (POPs) and manages referrals from the entire orthopaedic department, primary care, and other healthcare providers. The JHP is unique due to the creation of and utilization of the POP. The physical therapist goes through additional training to become the condition-specific provider to allow improved access of healthcare interventions frequently avoided by patients with knee and hip OA (e.g., diet and weight management, mental health). These evidence-based strategies are delivered by physical therapists serving as primary OA care providers that coordinate care within a multidisciplinary network of dieticians, behavioral health specialists, and orthopaedic providers.
Results: Patients participating in the JHP (n=2030) experienced significant improvements in physical performance measures, disability measures, improved psychological distress scores, and many avoided surgeries. In a subset analysis of patients (n=1504), 74.2% achieved minimal clinically important difference (MCID) and 57.4% achieved substantial clinical benefit (SCB). Of patients in the JHP who also received total joint replacement, 90.0% achieved MCID and 83.3% achieved SCD.