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Patients use fewer analgesics following supervised exercise therapy and patient education: an observational study of 16 499 patients with knee or hip osteoarthritis
  1. Jonas Bloch Thorlund1,2,
  2. Ewa M Roos1,
  3. Patricia Goro3,
  4. Emily Gromelsky Ljungcrantz3,
  5. Dorte Thalund Grønne1,
  6. Søren T Skou1,4
  1. 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
  2. 2Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
  3. 3School of Medicine, Örebro University, Örebro, Sweden
  4. 4Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
  1. Correspondence to Dr Jonas Bloch Thorlund, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; jthorlund{at}


Objectives To investigate changes in analgesic use before and after supervised exercise therapy and patient education in patients with knee or hip osteoarthritis (OA).

Methods We recruited 16 499 of 25 933 eligible patients (64%; mean age 64.9; SD 9.6; 73% women) from the Good Life with osteoArthritis in Denmark (GLA:D) registry. Change in proportions of analgesic users (categorised according to analgesic risk profile; opioids > non-steroidal anti-inflammatory drugs > paracetamol) was assessed from before to after an 8-week supervised exercise therapy and patient education programme targeting knee or hip OA pain and functional limitations.

Results Patients reported 13.2 mm (95% CI 12.8 to 13.6) less pain (visual analogue scale 0–100 mm) at follow-up compared with baseline. The proportion of analgesic users reduced from 62.2% (95% CI 61.5 to 63.0) at baseline to 44.1% (95% CI 43.3 to 44.9) at follow-up (absolute change: 18.1% (95% CI 17.3 to 19.0)). Among patients using analgesics at baseline, 52% changed to a lower risk analgesic or discontinued analgesic use. The proportion of opioid users after the exercise therapy was 2.5% (95% CI 2.1 to 2.9) lower than baseline; this represents a relative reduction of 36%.

Conclusion Among patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.

  • epidemiology
  • physiotherapy

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  • Twitter @jbthorlund, @ewa_roos, @STSkou

  • Contributors JBT, EMR and STS conceived and designed the study. PG, EGL and DTG cleaned and prepared the dataset for analysis. JBT conducted the statistical analysis. All authors participated in the interpretation of results. JBT drafted the first version of the manuscript. All authors helped in revising the manuscript and gave their final approval of the submitted version. JBT is the guarantor. All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analyses.

  • Funding This study was funded by Region Sjælland; H2020 European Research Council (Grant number: 801790).

  • Competing interests EMR and STS are developers of the Good Life with osteoArthritis in Denmark (GLA:D) programme, a not-for profit initiative to implement clinical guidelines in primary care. EMR is deputy editor of Osteoarthritis and Cartilage, the developer of Knee injury and Osteoarthritis Outcome Score (KOOS) and several other freely available patient-reported outcome measures. STS is an Associate Editor of Journal of Orthopedic & Sports Physical Therapy and has received grants from The Lundbeck Foundation, personal fees from Munksgaard, all of which are outside the submitted work. STS also report to currently be funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 801790).

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval According to the local ethics committee of The North Denmark Region, ethics approval was not required for the GLA:D registry. The GLAD database has been approved by the Danish Data Protection Agency and all patients provided consent to have their information registered in the GLA:D database.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data cannot be shared to a third party due to the General Data Protection Regulation.

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