Quality of nonpharmacological care in the community for people with knee and hip osteoarthritis.

摘要

OBJECTIVE: To assess the quality of nonpharmacological care received by people with knee and/or hip osteoarthritis (OA) in the community and to assess the associated factors. METHODS: We conducted a postal survey to evaluate 4 OA quality-of-care indicators for knee/hip OA: (1) advice to exercise; (2) advice to lose weight; (3) assessment for ambulatory function; and (4) assessment for nonambulatory function, including dressing, grooming, and arising from a seated position. Eligible participants were identified from the administrative database of British Columbia between 1992 and 2006. RESULTS: In total, 1349 participants reported knee and/or hip OA [knee only = 700 (51.9%); hip only = 261 (19.3%); knee and hip = 388 (28.8%)]. Their mean age was 67.1 years (SD 11.1); 816 (60.5%) were women, and 921 (68.3%) were diagnosed with OA for 6 years or longer. The overall pass rate of the 4 quality indicators was 22.4% (95% CI 20.5, 24.3). The pass rate for the individual quality indicator ranged from 6.9% for assessment of nonambulatory function to 29.2% for receiving assessment of ambulatory function. Receiving exercise advice was associated with having a university degree (vs high school diploma; OR 3.10, 95% CI 2.00, 4.80). Receiving weight-loss advice was associated with being female (OR 2.64, 95% CI 1.71, 4.08), being aged 55-64 years (compared to being aged 75 and over; OR 1.96, 95% CI 1.02, 3.76), and having higher Western Ontario and McMaster Universities Osteoarthritis Index scores (for every 10-point increment; OR 1.14, 95% CI 1.02, 1.26). On the other hand, having less than a high school education reduced the odds of weight-loss advice (OR 0.52, 95% CI 0.30, 0.88). CONCLUSION: The quality of nonpharmacological care for people with knee/hip OA in the community is suboptimal. Advice on exercise and weight management may not be provided equally across sex, age, disability, and formal education levels.