A program developed by Danish researchers is now a non-surgical option for Australians with osteoarthritis, explains HBF’s Dr Daniel Heredia.
One in five Australians over the age of 45 has osteoarthritis. The biggest risk factors are age, inactivity and obesity, and it is more common in people aged over 40 or those who have had a prior joint injury. Family history can also play a part.
For some people, symptoms are relatively mild but for others the symptoms are severe, ongoing and debilitating. The good news is that for most people, osteoarthritis can be effectively managed and the outlook is positive.
RACGP clinical guidelines recommend that joint replacement surgery is only considered once conservative management options (patient education and exercise therapy, combined with weight reduction, if necessary) have been exhausted.
However, the provision of lifestyle management support is relatively infrequent in Australia. Physiotherapy programs can be prohibitively expensive and even when exercise is recommended, patients are sometimes deemed to have failed non-surgical management without having received a sufficient exercise dose.
To support patients and referrers seeking high quality conservative management for OA, including adequately dosed exercise, HBF offers the internationally-recognised GLA:D program to eligible members at participating Life Ready clinics in WA.
What is GLA:D?
Good Life with osteoArthritis: Denmark (GLA:D) is an education and exercise program developed in 2012 by Danish clinical researchers to help people with hip or knee OA to manage or reduce their symptoms. Introduced in Australia in 2017, it is overseen by La Trobe University to ensure the program’s delivery is to University of Southern Denmark quality standards and guidelines.
Two group education sessions and 12 supervised small group exercise sessions (over six weeks) are delivered by physiotherapists or exercise physiologists who have been trained and certified by GLA:D Australia.
The program is based on evidence supporting the use of education and exercise therapy to manage hip and knee OA. While surgery can be a highly effective option for many people living with OA, GLA:D provides people with quality education and exercise support that can prevent the need for surgery.
All consenting program participants are enrolled into an online data registry – the largest allied health registry in Australia for any chronic health condition, according to Associate Professor Christian Barton, the co-project lead of the GLA:D Australia program. The registry is managed by researchers at La Trobe University and supports long-term evaluation of program efficacy in improving management of OA and surgery avoidance.
By December 2022, more than 2500 physiotherapists and accredited exercise physiologists across the country had completed training through GLA:D Australia.
HBF has funded certified training for 57 Life Ready physiotherapists and is the first private health insurer to offer GLA:D as a fully covered health support program to eligible members.
Why GLA:D?
The program’s efficacy now runs in Denmark, Canada, China, Switzerland, New Zealand, Australia and Germany. Between January 2018 and December 2021, more than 10,400 people had undertaken the program in Australia, of which:
- 82% reported their knee as their primary problem joint
- 80% of the knee participants and 71% of hip participants were overweight or obese
- 74% of knee and 68% of hip participants had OA symptoms for more than a year when starting GLA:D
- 42% of knee and 25% of hip participants had undergone previous surgery
- 61% of knee and 58% of hip participants had other health conditions such as high blood pressure and high cholesterol.
After three months and 12 months:
- the average knee/hip pain intensity decreased and was maintained
- medication use decreased and was maintained
- average joint-related quality of life increased, and
- participation in and confidence undertaking physical activity increased.
In addition, a substantial proportion of participants who wanted surgery at baseline had not had surgery and no longer desired it after the program, reflecting a shift in attitudes and suggesting an opportunity for minimising unwarranted surgery.
The program is safe for older adults and has advantages beyond OA management. Many Australians with OA have at least one other chronic disease – most commonly cardiovascular disease, back pain and mental health conditions, all of which can benefit from increased exercise and physical activity.
ED: Dr Daniel Heredia is HBF’s Executive General Manager Insurance and Health Services.