Implementation of the Good Life with osteoArthritis in Denmark (GLA:D®) program via telehealth in Australia: A mixed-methods program evaluation

Allison M Ezzat; Joanne L Kemp; Joshua J Heerey; Marcella F Pazzinatto; Danilo De Oliveira Silva; Karen Dundules; Matthew Francis; Christian J Barton

doi:10.1177/1357633X231167620

Implementation of the Good Life with osteoArthritis in Denmark (GLA:D^®) program via telehealth in Australia: A mixed-methods program evaluation

J Telemed Telecare. 2023 Apr 20:1357633X231167620. doi: 10.1177/1357633X231167620. Online ahead of print.

Authors

Allison M Ezzat^{1

2}, Joanne L Kemp^{1

3}, Joshua J Heerey¹, Marcella F Pazzinatto¹, Danilo De Oliveira Silva¹, Karen Dundules¹, Matthew Francis¹, Christian J Barton^{1

3}

Affiliations

¹ La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
² Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
³ Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.

PMID: 37082796
DOI: 10.1177/1357633X231167620

Abstract

Introduction: We aimed to evaluate the implementation of the Good Life with osteoArthritis in Denmark (GLA:D^®) program via telehealth in Australia using Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation framework.

Methods: Using a convergent mixed-methods design, semi-structured one-on-one interviews with physiotherapist adopters and nonadopters of GLA:D^® via telehealth were analyzed thematically alongside the examination of registry data (1 March 2020-10 February 2022) from patients with hip or knee osteoarthritis completing GLA:D^® via telehealth (telehealth-only) or combined with in-person care (hybrid). Effectiveness was determined as changes from baseline to 3-month follow-up (mean differences, 95% confidence intervals, effect size) for Knee injury and Osteoarthritis Outcome Score (KOOS-12)/Hip disability and Osteoarthritis Outcome Score-12 (HOOS-12), and chair stand test. Group- and individual-level changes were compared to published minimally clinically important change scores.

Results: Twenty-three interviews (12 adopters, 11 nonadopters) found key barriers/facilitators to reach and adoption, high perceived effectiveness, and strategies to support sustainability. Of 2612 registered patients, 85 (3%) and 115 (4%) completed GLA:D^® via telehealth-only or hybrid model, respectively. Most effectiveness outcomes were associated with moderate-large improvements. Group-level changes exceeded minimally clinically important change values for KOOS/HOOS-quality of life and chair stand test. Nearly two out of three patients reached a minimally clinically important change for KOOS/HOOS-quality of life. With telehealth-only and hybrid delivery, 99% (n = 82) and 85% (n = 97) were satisfied/very satisfied. Physiotherapist adoption was limited (n = 128, 6%).

Discussion: GLA:D^® delivered via telehealth is effective, had high patient satisfaction, and was perceived positively by physiotherapist adopters. Addressing low reach and adoption requires further implementation strategies to facilitate greater telehealth opportunities for patients and physiotherapists.

Keywords: Osteoarthritis; exercise; implementation; physiotherapy; program evaluation; telehealth.