A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial.



Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused.


To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes.


Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740).


Department of Veterans Affairs Medical Center in Durham, North Carolina.


30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis.


The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record.


The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes.


At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ.


The study was conducted in a single Veterans Affairs medical center.


The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.

Primary funding source

Department of Veterans Affairs, Health Services Research and Development Service.





Published Version (Please cite this version)


Publication Info

Allen, Kelli D, William S Yancy, Hayden B Bosworth, Cynthia J Coffman, Amy S Jeffreys, Santanu K Datta, Jennifer McDuffie, Jennifer L Strauss, et al. (2016). A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial. Annals of internal medicine, 164(2). pp. 73–83. 10.7326/m15-0378 Retrieved from https://hdl.handle.net/10161/29946.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Kelli Dominick Allen

Adjunct Professor in the Department of Medicine
  • Improving care and outcomes for individuals with osteoarthritis and other musculoskeletal conditions with an emphasis on non-pharmacological therapies including physical activity, weight management, rehabilitation services, and pain coping
    * Understanding rand reducing disparities in musculoskeletal conditions
    * Musculoskeletal conditions in U.S. military Veterans
    * Pragmatic clinical trials
    * Adaptive interventions

William Samuel Yancy

Professor of Medicine

Impact of obesity on health, health care delivery, quality of life.
Diet and other weight loss interventions
Preventive medicine


Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy


Cynthia Jan Coffman

Professor of Biostatistics & Bioinformatics

Jennifer Leigh Strauss

Associate Professor in Psychiatry and Behavioral Sciences

Eugene Zaverio Oddone

Professor Emeritus of Medicine

I am a health services researcher whose primary research interests are: 1) evaluating the effectiveness of primary care with an emphasis on chronic disease, 2) assessing the reasons and testing interventions to reduce racial variation in access the health care and utilization of health services, 3) determining appropriate interventions to improve blood pressure control for hypertensive patients treated in primary care. I have research expertise in racial variation, blood pressure control, disease management, and tele-medicine. I also have methodologic expertise in designing and testing health services interventions in multi-site clinical trials.

Key words: primary care, racial variation, quality of care, hypertension

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.