A new study evaluates how the GLA:D program run virtually compares to in-person models.
Osteoarthritis management programs delivered virtually or in hybrid formats are as effective as traditional in-person models for most key outcomes, researchers suggest.
The study, published in Arthritis Care & Research, set out to determine if program format (in-person, virtual, hybrid) results in differences in three-month outcomes of pain, function, quality of life, self-efficacy and chair stands in a hip/knee osteoarthritis management program.
“Many programs designed to help individuals self-manage their OA are in-person,
introducing a substantial barrier for some populations,” the authors wrote.
“Alternatively, there are some virtual OA programs which have demonstrated feasibility, acceptability and improved outcomes (decreased pain and disability, improves function, QoL) for individuals with OA.
“However, many programs focus on education, self-guided exercise modules without feedback on technique or safety, or only target individuals pre or post total joint replacement (TJR).
“Additionally, several of the identified virtual programs describe an in-person component, better reflecting a hybrid approach. OA management programs can reduce the direct (medications, assistive devices, rehabilitation, etc.) and indirect (transportation costs, time off work, childcare, etc.) healthcare costs associated with OA.
“Virtual OA management programs may be more appealing than in-person formats because it saves participants both time and money. However, healthcare providers have raised concerns over the reliability of virtual assessments and the quality of virtual care in relation to patient outcomes.”
The researchers noted that there had been a significant focus on validating virtual patient-reported measures and performance-based measures since the covid pandemic, that have found virtual assessments to be “feasible, reliable and valid”.
“Preliminary evidence supports that virtual program outcomes may be equivalent to in-person programs for participant pain and function,” they wrote.
Enter the Good Life with osteoArthritis in Denmark (GLA:D) Canada program, which delivers the same program for hip and knee OA with in-person, virtual and hybrid formats.
The program originated in Denmark and was implemented in Canada in 2016. The GLA:D Canada program consists of two group education and 12 group exercise sessions over six weeks and collects patient-reported and performance-based outcomes.
Unlike many virtual and hybrid programs, each education and exercise session of the program is therapist-led.
As part of their study, the researchers compared program outcomes across in-person, virtual and hybrid formats, to see whether there were differences in three-month patient-reported outcomes of pain, function, QoL, self-efficacy and chair stands between participants who complete an in-person, virtual or hybrid program.
Multiple linear regression was completed for pain and function, analysis of covariance for quality of life and self-efficacy, and negative binomial regression was completed to analyse chair stands.
Outcome measures included the 12-item Knee/Hip Injury and Osteoarthritis Outcome Score (pain, quality of life and physical function subscales), Arthritis Self-efficacy Scale (self-efficacy) and 30-second chair stand test. Models were adjusted for different covariates.
The analyses included 5062 individuals with knee and/or hip osteoarthritis who completed the program between January 2019 and March 2024 (76.7% female sex, mean age=67.27 years, mean BMI=29.51 kg/m2).
When compared to in-person formats, there was no difference in virtual or hybrid formats at three months for pain, quality of life or self-efficacy.
When compared to in-person, the virtual format resulted in lower function scores (B=-1.71, 95% CI -2.78, -0.63) and the hybrid format performed 3% fewer chair stands at three-months (incidence rate ratio=0.97, 95% CI 0.93, 0.99), which was not regarded as a clinically important change.
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“While this study identified that there were statistical differences between in-person and virtual for function, and in-person and hybrid for chair stands, these differences were small and likely do not represent clinically meaningful difference,” the researchers explained.
“The virtual group function scores were only 1.71 points less than in-person, well below the MCID of 14. Similarly, the hybrid group performed 3-5% fewer stands compared to the in-person group which translates to only roughly half a chair stand and does not surpass the MCID of two.
“For a 3-5% difference to be clinically meaningful a participant would need to have completed 40 chair stands. However this remains is an interesting finding and given how hybrid data is defined in the GLA:D dataset, it is plausible that this finding may be due to a lack of consistency regarding the conducting of baseline and three
months assessments in the same format (i.e., virtual or in-person) and with the same equipment (i.e., standardisation of chair).”
The researchers said virtual and hybrid formats continued to demonstrate favourable outcomes in OA patients that appeared to be equivalent to in-person approaches.
This may improve access to OA rehabilitation, improve outcomes, reduce program costs and mitigate scheduling issues.
“The results of this study suggest that ongoing support for the offering of virtual and hybrid approaches is warranted, while acknowledging the need for additional research,” the researchers concluded.
“Based on the results of this study some outcome measures, like chair stands, merits additional research to identify if true differences exist between groups. Future work on virtual and hybrid approaches may benefit from a focus on how to best implement these formats to optimise clinician and participant experience and outcomes, which may help advocate for investment into these alternative approaches to care.
“For now, clinicians and participants can remain confident in virtual and hybrid formats of the GLA:D Canada program.”
