BABS (Becoming Active in Beating osteoarthritiS): a cluster randomized controlled trial evaluating an information campaign to improve osteoarthritis care and management in Dutch general practices

BACKGROUND: The aim of our study was to examine the effectiveness of an information campaign using behavioral change techniques (BCTs) targeting both individuals with early stage knee and hip osteoarthritis (KHOA) and healthcare providers (HCPs) to improve beliefs about non-surgical treatments, and ultimately, to optimize utilization of non-surgical treatment options in primary care. METHODS: We used a cluster randomised design with general practices serving as cluster units. Eligible patients were Dutch-speaking, aged 50-75, registered with KHOA, without joint replacement or considerable walking impairment. The primary outcome was the proportion of patients for whom treatment was restricted to primary care over 12 months as reported by patients. Secondary outcomes included quality of care, treatment beliefs, physical activity (PA), self-management, and beliefs of HCPs affiliated with participating practices. Patient participants received online questionnaires at baseline, 6 and 12 months. HCPs received online questionnaires at baseline and after 12 months. Multilevel mixed-effects logistic regression was used for the primary outcome, linear regressions with change scores were used for secondary outcomes. RESULTS: Fourteen general practices, 34 HCPs and 235 patient participants participated. In the intention to treat analysis (n = 211), treatment of 54 (52%) patient participants was restricted to primary care in the intervention group versus 44 (41%) in the control group (OR 1.60, 95% CI 0.88;2.84, NS). PA beliefs were less negative for the intervention group at T6 (β = -0.62, 95% CI -1.04;-0.20) and T12 (β = -0.63, 95% CI -1.23;-0.03) than for the control group. Furthermore, participants in the intervention group were more physically active at T6 (β = 1574, 95% CI 40;3108) than the control group. HCPs medication beliefs were more positive for the intervention group than the control group (β = -0.58, 95% CI 0.15;1.01). No other significant effects were found. All effect sizes were small and not clinically relevant. CONCLUSION: Educating patients and HCPs using BCTs did not affect referral patterns, but might positively influence treatment beliefs in KHOA care. TRIAL REGISTRATION: International Clinical Trial Registry Platform (ICTRP), trial number NL9140, registration date 23-12-2020.