The purpose of the SAMBA study was to investigate whether the introduction of a new, evidence-based treatment model in the municipal health service for people with hip and knee osteoarthritis led to
- better quality of treatment, i.e. if the treatment was more in line with treatment recommendations
- that GPs referred more patients to physiotherapists
- that physiotherapists sent more discharge summaries to referring doctors
- better health outcomes for patients
- reduction in the proportion of "unnecessary" referrals to orthopedics where first-line treatment has not been tried first
- reduction of referrals to MRI for assessment of osteoarthritis
- higher patient satisfaction with treatment
- changes in health-related lifestyle, such as being physically active in line with physical activity recommendations and maintaining a healthy body weight
Recruitment is closed.
Included patients were adults in need of treatment due to osteoarthritis of the hip or knee.
The model was implemented in six municipalities in Øvre Romerike. A summary of international treatment recommendations and the SAMBA model was presented to GPs and physiotherapists at a joint professional meeting. An orthopaedic surgeon also attended the meeting and discussed when it is appropriate to refer patients for assessment by an orthopaedic surgeon. The physiotherapists also attended a full-day course organized by "Active with osteoarthritis (AktivA)", where the treatment recommendations were elaborated on and they were given ready-made material for holding group-based osteoarthritis courses and guided training for patients with hip and knee osteoarthritis.
In the SAMBA model, the GP provided patients with hip and knee osteoarthritis with information about treatment options for osteoarthritis, prescribed painkillers or anti-inflammatory drugs if necessary, and referred them to a physiotherapist. The physiotherapists arranged a group-based osteoarthritis course followed by a supervised exercise follow-up of 8-12 weeks. At the end of the training period, the patient and the GP discussed the effect of the treatment. Together, they assessed whether the patient could continue training on their own, needed a new referral to physiotherapy or whether the osteoarthritis had worsened and it was appropriate to refer the patient to an orthopaedic surgeon for consideration of surgery.
The SAMBA study was a collaboration between six municipalities in Øvre Romerike (Eidsvoll, Gjerdrum, Hurdal, Nannestad, Nes and Ullensaker), the Orthopaedic Clinic at Akershus University Hospital and the research groups at the National Competence Center for Rheumatological Rehabilitation at Diakonhjemmet Hospital and the Department of General Practice at the University of Oslo.