Implementing a Guideline-based Model of Care for Hip and Knee Osteoarthritis in Finland. A Benchmarking-controlled Trial (FIN-OA)

Osteoarthritis (OA) is a growing global health challenge, due to the significant increase in prevalence of knee and hip OA. In Finland, OA care costs are substantial, driven by diagnostic procedures, medical treatments, and indirect costs such as work absenteeism. The international guidelines recommend education, exercise, and weight management as first-line treatment options, but adherence to guidelines is inconsistent. This project aims to explore regional differences in OA care and beliefs and OA care practices in Finland. In addition, we will implement and evaluate a guideline-based model of care for hip and knee OA, that includes the Good Life with osteoarthritis from Denmark (GLA:D®) program as the preferred non-surgical management option in local care pathways. In addition, the aim is to share evidence-based OA knowledge and management skills nationwide.

This study is a hybrid type-3 benchmarking-controlled implementation trial. It is nested in primary healthcare in two Wellbeing Services Counties. The study includes three phases: pre-implementation, implementation, and evaluation. The pre-implementation activities include mapping the current OA care through registry review (healthcare utilization and costs from 2019-2024). In addition questionnaires and interviews of patients and healthcare professionals (beliefs and practices) will be conducted. Planned activities of the implementation phase include developing and integrating a new model of care (including GLA:D®) into local care pathways, and training physiotherapists to deliver it. Implementation theories and multifaceted implementation strategies will be used and adapted locally. The activities to evaluate the process include assessment of the implementation outcomes on healthcare professional and organizational levels, healthcare resource utilization and cost outcomes (1, 3 and 5 years) using registry data. In addition outcomes reported by patients participating in the GLA:D program will be collected at 3 months and 1, 3 and 10 years.

This project aims to bridge the gap between guideline-recommended OA-management and clinical practice. By implementing a systematic, evidence-based model of care, the study seeks to improve patient outcomes, reduce healthcare costs, and provide equitable access to care. The findings will inform future OA care strategies and will be disseminated and adapted to other healthcare contexts in Finland and can be adapted also internationally. The findings will be published in peer-reviewed journals and presented in national and international conferences.

• Number of trained GLA:D trainers and physiotherapists [Time frame: 1, 3 and 5 years after implementation]
• Participation of patients in GLA:D program [Time frame: 1, 3 and 5 years after implementation]
• Pain intensity during last week, numerical rating scale [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• Problems walking due to knee /hip [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• UCLA activity score [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• Fear of movement [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• Use of painkillers [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• Current employment [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• Sick leave because of knee / hip during last year [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• EQ-5D-5L [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• K/HOOS-12 [Time frame: Baseline, 3 months, 1, 3 and 10 years]
• Global perceived effect [Time frame: 3 months, 1, 3 and 10 years]