Authors (including presenting author) :
Chow TL(1), Ho HT(2), Lam CW(3), Ching WK(4), To YL(5), Lau PW(5) Leung SY(1), Leung KW(1)
Affiliation :
(1)Department of Family Medicine, NTEC, (2)Occupational Therapy, PWH, (3)Physiotherapy, PWH, (4)Occupational Therapy, NDH, (5)Physiotherapy, NDH
Introduction :
Knee osteoarthritis (OAK) is a highly prevalent degenerative condition causing significant physical and psychological impairment. Currently the OAK management in primary care is fragmented and inefficient, leading to high healthcare cost and hospital burden. A pilot “Self-Management of Illness & Leading to Empowerment Program for OAK patients” (SMILE OAK) was initiated to provide early management and selfcare education to OAK patients through a stepped, protocol driven, multidisciplinary care approach.
Objectives :
To evaluate the effectiveness of the SMILE OAK program.
Methodology :
North district GOPC patients with clinically diagnosed OAK were recruited by Musculoskeletal team of Family medicine, to receive 4 weekly sessions of patient education and supervised exercise in group of 5, provided by physiotherapist (PT) and occupational therapist (OT), emphasizing on patient empowerment. After completion of group classes, patients who did not meet the pre-defined outcomes would be referred to individual PT and OT therapy in North District Hospital (NDH). If patients still could not achieve the clinical outcomes after individual therapy, they would be referred to Fanling Family Medicine Specialist Clinic (FMSC) for doctor consultation. Outcomes: (1) Numeric pain rating scale (NPRS) (2) Timed up and go test (TUG) (3) Knee injury and Osteoarthritis Outcome Score (KOOS) (4) Quality of life (QoL) measured by well being index (WHO5) before and after treatment (5) Numeric global rating of change scale (NGRCS) (6) Patient satisfaction (7) Referral rate for stepped-up care.
Result & Outcome :
Total 151 subjects were recruited from May to November, 2022. There were significant improvement in NPRS (Pain), TUG (Functional ability), KOOS score (Assess Pain, symptoms, ADL, function and QoL) and WHO5 (QoL) when comparing the pre and post-treatment outcome (p < 0.001). Patients in SMILE program also experienced overall 48.51% (SD±1.93) improvement measured by NGRCS. Over 70% of patients were satisfied with SMILE program and established exercise habit after the program. 10% of patients were referred to NDH allied health for further intervention to improve the outcomes. There were nil referrals to FMSC or Orthopaedic SOPC for stepped-up consultation. The 4 weekly structured SMILE OAK program in GOPC can significantly improve knee pain, functionality and overall well-being in OAK patients. This stepped care model is useful to reduce allied health burden and unnecessary healthcare utilization.
