Optimising the Provision of Exercise for People with Knee and/or Hip Osteoarthritis in Primary Care: An individual Participant Data Network Meta-analysis and Community of Practice

PI Title: Professor Melanie Holden

Lead member: Keele

"AIM: To understand the best way to provide exercise for people with knee and hip osteoarthritis within the United Kingdom (UK) National Health Service (NHS).

BACKGROUND: Osteoarthritis of the knee and hip is very common. It causes pain, movement problems, and can make daily life difficult. Exercise is recommended for people with knee and hip osteoarthritis. To explore whether exercise helps, we recently combined data from 4241 people across the world with knee and hip osteoarthritis who had taken part in 31 clinical trials of exercise (STEER OA study). Our analysis found that people with worse pain and poorer physical function benefited the most from exercise.

In the UK, exercise for people with knee and hip osteoarthritis is often delivered by physiotherapists. However, physiotherapy services are under pressure. They have long waiting lists, and only a limited number of treatment sessions can be provided. This might mean that exercise is not offered in the best way possible. To improve outcomes for patients, and to help the NHS run well, we need to find new ways to offer high quality exercise for people with knee and hip osteoarthritis.

DESIGN: This research includes two Work Packages. In Work Package One, we will analyse data from the STEER OA study to find out if certain ways of providing exercise are better than others. For example, we want to know if certain types of exercise are better than others (e.g walking or strength training), and if supervised exercise is better than un-supervised exercise. In Work Package Two, we will bring together 15 people with experience of exercise for knee and hip osteoarthritis, including health care professionals like physiotherapists and doctors, their managers, people who make decisions about funding health services (commissioners), and patients. We will make sure that under-served communities (e.g. people of Black and Caribbean heritage) are included in our group. We will discuss how exercise is currently delivered, and the findings of our analysis. Together, we will develop recommendations about offering exercise for people with knee and hip osteoarthritis within the NHS. We will also develop strategies to help health services adopt this new way of providing exercise.

PATIENT AND PUBLIC INVOLVEMENT (PPI): Our STEER OA PPI group told us that before deciding how to offer exercise, it was important to understand if certain ways of providing exercise are better than others. Their feedback directly informed this application. A patient representative has joined the study team and has jointly developed PPI plans. Importantly, this includes involving patients in Work Package Two.

DISSEMINATION: We will present the findings at national and international meetings, and publish the results in high-quality medical journals. Our PPI member will help write summarises of the findings for lay audiences."

Amount awarded: £248,769