POS1465-HPR ANALYZING GLA:D® OSTEOARTHRITIS IMPLEMENTATION FIDELITY IN GERMAN-SPEAKING SWITZERLAND: UNCOVERING DEVIATIONS AND EXAMINING THEIR CAUSES
Authors: A. Lehni, K. Niedermann
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Knee and hip osteoarthritis (KHA) are a major cause for chronic pain, disability, and loss of quality of life worldwide. International clinical guidelines state that people with KHA should receive education, exercise, and weight management if appropriate. Several programmes translate these recommendations into structured programmes, among them the GLA:D® (Good Life with osteoarthritis in Denmark) programme, which is implemented internationally. In Switzerland, GLA:D® Switzerland (GLA:D® CH) has been successfully implemented since 2019, with approximately 8000 participants and nearly 1000 GLA:D® certified physiotherapists (GLA:D® PTs). GLA:D® CH consists of four individual sessions, followed by two group education sessions and then 12 group exercise sessions. Its features and state-of-the art execution are taught in 2-day certification courses. However, it is unclear, to what extent the Swiss GLA:D® PTs implement the program in clinical practice. Having knowledge about this, will determine the fidelity to implementation of GLA:D® CH. <h3>Objectives:</h3> This study investigates the fidelity of implementation in the GLA:D® CH program and the reasons for deviations. <h3>Methods:</h3> A cross sectional study using an adapted structured questionnaire was performed among the GLA:D® PTs. The questionnaire was designed to capture the fidelity of healthcare providers using four Dimensions 'Adherence', 'Quality', 'Dosage' and 'Exposition'. The existing literature posits that a statement regarding the fidelity of a health intervention can be made when all four dimensions of a healthcare intervention are explored. Cut-off scores for high-medium-low fidelity were predetermined based on current literature. Descriptive statistics was performed, with frequencies and percentages of high-medium-low fidelity scores and cut-off values. Inductive qualitative content analysis was performed for open-ended questions and identified deviations were ranked dependent on their frequency. <h3>Results:</h3> GLA:D® PTs achieved an average fidelity score of 85% over all four dimensions. In the dimension 'Adherence',fidelity score was 76%; in'Quality fidelity score was 94%; in 'Exposure'fidelity score was 79% and in the Dimension 'Dosage' fidelity score was 90%. The qualitative analysis revealed deviations from the state-of-the-art as taught in the certification courses occurred mainly in the structuring and number of the four individual sessions and in the order of the educational sessions. Further there were deviations in the target group size based on recruitment problems, keeping the pain diary and in the performance (or not performance) of walking and stretching exercises. <h3>Conclusion:</h3> High fidelity was identified in the dimensions 'Quality' and 'Dosage' However medium and low fidelity was identified in the dimension 'Adherence' and 'Exposure' respectively. Thus, there is potential for improvement in these two latter dimensions. Either by more consistent teaching in the certification course or by adaptations based on the open responses from the GLA:D® PTs. A possible solution could involve adjusting the structure of the four individual sessions in the certification course or developing a mobile application for conducting walking and stretching exercises at home.REFERENCES: NIL. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>