GLA:D – THE LATEST FINDINGS

Mimi Yamakawa-Armstrong

October 27, 2023

WHAT IS GLA:D?

GLA:D program (Good Life with osteoarthritis from Denmark) is a worldwide program developed by researchers in Denmark for people with knee and hip arthritis. It is anticipated that the GLA:D program for osteoarthritis will become the standard first line care for people suffering from osteoarthritis and multimorbidity. GLA:D encompasses an education and exercise program that ensures participants improve confidence and strength when exercising and create the opportunity for self-management of their osteoarthritis (Annual Report 22,3;2). Currently 1 in 5 Australians over the age of 45 experience knee and hip osteoarthritis, becoming a major health concern. The GLA:D Annual Report 2022 statistics indicated 12,884 Australian participants who took part in the GLA:D program between January 2018 and December 2022 had a high success rate. After implementing GLA:D the average knee pain intensity decreased by 31% and hip pain decreased by 28%.

THE LATEST FINDINGS

GLA:D has reported consistent results with reduced average pain, pain medication intake and improved quality of life.

Physical function + Quality of life

Physical functions measured by the number of sit to stand in 30 seconds showed 27% improvement, that is 14 repetitions post-program from 11 repetitions before-program. Improvement in walking speed by 14% for the knee and 12% for the hip participants is also reported.

What about surgery?

In the 2021 report (@12 months) 63% of the knee and 49% of the hip participants who desired surgery pre-program reported they had not received surgery and no longer desired to have surgery. In the 2022 report: 75% of the knee participants and 63% of the hip participants who desired surgery pre-program reported they had not received surgery and no longer desired to have surgery.

OBJECTIVES

GLA:D Australia is aiming to assist acceleration implementation of the national clinical guidelines to clinical practice. Their overall objective is to ensure

1. All people with osteoarthritis have equal access to evidence-based treatment irrespective of residence and financial situations

2. Surgery is only considered when non-surgical measures have not led satisfactory outcomes.

These objectives provide the best possible patient centered outcomes. This often means surgery is avoided. Strengthening is often more favorable on patient perceived outcome scores when compared to surgery. This also comes at a significantly lower cost and decreases the risk of surgery related comorbidities.

Additionally, in 2022 a further 36 courses were delivered and physiotherapists and exercise physiologists trained. Pilot training for exercise physiologists has been implemented in Australia for the first time. GLA:D Australia is now training both physiotherapists and exercise physiologists. Training exercise physiologists and additional physiotherapists will potentially assist accessibility of the program, creating more opportunity for individuals with osteoarthritis to participate. Currently there are more private clinics (86%) delivering the program than public clinics (10%).

IS THE GLA:D PROGRAM ACCESSIBLE

The ideology of GLA:D insures that it’s accessible for all, for this reason it is very cost effective. The first session and the last session are charged at a 1:1 fee. Health care card rebates are available for this, as well as Medicare EPC rebates. Subsequent group sessions are less than half the cost of a standard 1:1 session ensuring the patient is able to come for the full six weeks. Telehealth is also available for participants who are unable to attend in clinic session.

GLA:D AT GRAND SLAM PHYSIOTHERAPY

Glad is rolled out initially with a one to one session, whereby the physiotherapist does a series of tests to establish a baseline and then demonstrate all of the exercises involved throughout the program. There is also an element of education in this initial one to one session. Following this, the patient is booked into twice weekly exercise sessions for 6 weeks.

The rationale for this is that the patient is highly supervised and can feel confident that they are doing the exercises in the correct way safely and getting the most benefit from the exercise. By default, there is also a great support network established with other patients in the group that are undergoing the same journey. Patients often report about how much fun they have, how it can be social outlet and distraction from the chore of rehab. Participation in a gym environment can also increase confidence for the long-term post discharge.

SUMMARY

The improved quality of GLA:D delivery by clinicians as well as the increased public knowledge around the effectiveness of exercise for chronic muscular skeletal conditions has allowed for these findings to occur.

If you are interested in the full report please refer to www.gladaustralia.com.au various resources for both clinicians and patients are available.

ABOUT MIMI

With a post graduate in Paediatric Physiotherapy, Mimi enjoys treating children and adolescents and has a special interest in spinal, neck and hip injuries. Mimi is has just completed her Sports & Exercise Physiotherapy Masters and is a Titleist Performance Institute certified golf screening practitioner. Mimi is currently only taking Telehealth appointments (until late 2023).

REFERENCES

M Ezzat A, Kemp JL, J Heerey J, et al. Implementation of the Good Life with osteoArthritis in Denmark (GLA:D®) program via telehealth in Australia: A mixed-methods program evaluation. Journal of Telemedicine and Telecare. 2023;0(0). doi:10.1177/1357633X231167620

Avantika Bhardwaj, Caoimhe Barry Walsh, Allison Ezzat, Cliona O’Riordan, Norelee Kennedy & Clodagh M. Toomey (2023) Patient and clinician perspectives of online-delivered exercise programmes for chronic musculoskeletal conditions: a mixed-methods systematic review, Disability and Rehabilitation, DOI: 10.1080/09638288.2023.2224085

GLA:D Australia Annual Report (2022) https://gladaustralia.com.au/wp-content/uploads/2023/05/GLAD-Annual-Report-2022.pdf