Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis

• Published in: Osteoarthritis and cartilage open Vol. 3; no. 3; p. 100175
• Main Authors: Barton, Christian J., Kemp, Joanne L., Roos, Ewa M., Skou, Soren T., Dundules, Karen, Pazzinatto, Marcella F., Francis, Matthew, Lannin, Natasha A., Wallis, Jason A., Crossley, Kay M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2021; Elsevier
• Subjects: Education; Exercise; Implementation; ORIGINAL PAPER; Osteoarthritis; Physiotherapy; Program evaluation; Program evaluation; Exercise; Education; Osteoarthritis; Implementation; Physiotherapy
• ISSN: 2665-9131; 2665-9131
• DOI: 10.1016/j.ocarto.2021.100175

Evaluate the implementation of Good Life with osteoArthritis from Denmark (GLA:D®) for knee osteoarthritis in Australia using the RE-AIM QuEST (Reach, Effectiveness, Adoption, Implementation, Maintenance Qualitative Evaluation for Systematic Translation) framework. Physiotherapists completed surveys before and after GLA:D® training (2017–2020) to assess practices, and barriers and enablers to implementation. Patients completed online baseline, 3-month (post-treatment) and 12-month patient reported outcomes. Effective implementation was defined as within-participant moderate effect size (ES, ≥0.50) for average pain (100 ​mm VAS) and Knee Injury and Osteoarthritis Outcome Score quality of life scores (KOOS-QoL), and small effect size (≥0.20) for health-related quality of life (EQ-5D-5L). Reach: 1064 physiotherapists and 1945 patients from all states and territories participated. Key barriers included out-of-pocket cost to patients, and program suitability for culturally and linguistically diverse communities. Effectiveness: Following training, more physiotherapists reported discussing treatment goals and weight management, and prescribing supervised, neuromuscular exercise. Patient outcomes at 3- and 12-months (n ​= ​1044 [54%] and 927 [48%]) reflected effective implementation, including reduced pain (ES, 95%CI ​= ​0.72, 0.62–0.84; and 0.65, 0.54–0.77) and improved KOOS-QoL (0.79, 0.69–0.90; and 0.93, 0.81–1.04) and EQ-5D-5L (0.43, 0.31–0.54; and 0.46, 0.35–0.58) scores. Adoption: 297 sites (264 private, 33 public) implemented GLA:D®. Implementation: Most patients completed at least one education (90%), and 10 exercise-therapy (78%) sessions. Adequate staffing to support program delivery was a key enabler. Maintenance: 99% of sites (293/297) continued offering the program in July 2020. Training changed practice and was associated with effective widespread implementation of GLA:D® in Australia.