Clinical Outcomes of OA Management Programs – an international consortium using Individual Participant Data: COOPERATe


Despite the existence of well-developed osteoarthritis (OA) management guidelines for more than a decade, it appears that the majority of people with osteoarthritis still don’t receive appropriate care. In an effort to address this evidence-practice gap, there is growing international interest in the development and implementation of coordinated OA management programs (OAMPs). There are marked differences in the models of service delivery of international OAMPs that have been implemented across a range of healthcare systems and settings. Further, the actual ingredients of these complex interventions appear to vary widely: the interventions offered; treatment mode, delivery, intensity and duration; and healthcare professionals delivering the treatments. The outcomes of different models of international OAMPs are unlikely to ever be compared in clinical trials, particularly due to the huge expense and complicated logistics required. Prognosis research provides another method of comparing participant outcomes of different OAMP models.

The primary objectives of this study are to examine the outcomes (pain and function) of people with hip or knee osteoarthritis who have participated in structured OAMPs and to identify prognostic factors at the individual participant level that are associated with improvements in pain and function.


This is a project of the Joint Effort Initiative (JEI). The JEI, endorsed by the Osteoarthritis Research Society International (OARSI) is a consortium of >100 researchers, clinicians and consumers with common interests in the implementation of OAMPs. We will identify international OAMP clinical cohort studies through members of the JEI and literature searches. Longitudinal clinical cohorts of OAMPs will be eligible if they are derived from a hip/knee OAMP, delivered in any real-world setting and include the following:

  • Personalised OA management implemented as a package of care with reassessment and progression;
  • Minimum of two core treatments of education, exercise, and/or weight-loss, +/- optional adjunctive treatments;
  • Longitudinal measurements of pain and function.

The investigators of eligible clinical cohort studies will be invited to participate and contribute individual participant data (IPD). Clinical cohort-level outcomes and participant-level characteristics of included studies will be summarised. We will use multivariable linear regression, where final pain and function measurements are the outcomes, adjusting for baseline values as covariates and stratifying by the study.  If there is considerable heterogeneity within the cohorts, we will consider using random-effects models to estimate the pooled change. The IPD will be further analysed to examine characteristics that are associated with pain and function at the individual patient level.


Data delivery ongoing

Protocol and publications


J. (Jillian) Eyles 1
J. (Jocelyn) Bowden 1
D. (David) J. Hunter 1
A. (Allan) Abbott 2
J.H. (Haxby) Abbott 3
S. (Sita) M.A. Bierma-Zeinstra 4
L. (Leif) Dahlberg 5
K. (Krysia) Dziedzic 6
M. (Martin) van der Esch 7
M. (Melanie) E. Holden 6
E. (Emma) Healey 6
I. (Inger) Holm 8
M. (Michael) Hurley 9
C. (Carolyn) Hutyra 10
W. (William) Jiranek 10
T. (Thérése) Jönsson 11
T. (Trevor) Lentz 10
G. (Gunilla) Limbäck Svensson 12
S. (Stefan) Lohmander 13
M. (Morven) Malay 14
R. (Richard) Mather III 10
M. (Marienke) van Middelkoop 15
K. (Kathryn) Miller 16
T. (Tuva) Moseng 17
H. (Håkan) Nero 5
N. (Nina) Østerås 17
M.A. (May Arna) Risberg 18
I. (Inger) Holm 19

1. Level 10, Kolling Institute, Westbourne St, St Leonards, Sydney, NSW, Australia.
2. Institution for Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University,581 83 Linköping, Sweden.
3. Centre for Musculoskeletal Outcomes Research, Otago Medical School, University of Otago, Dunedin, New Zealand.
4. Erasmus MC – University Medical Centre Rotterdam, Rotterdam, The Netherlands.
5. Orthopedics, Department of Clinical Sciences, Lund University, Sweden. Joint Academy, Malmö and Lund University, Lund, Sweden.
6. School of Medicine, Keele University, United Kingdom.
7. Reade Centre for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Centre University of Applied Sciences, Amsterdam, The Netherlands.
8. Division of Orthopaedic Surgery, Department of Research and Development, Oslo University Hospital, Oslo, Norway.
9. Faculty of Health, Social Care and Education, St George’s University of London and Kingston University United Kingdom.
10. Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, United States of America.
11. Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden,
12. Dept of Orthopaedics, Inst of Clinical Sciences, University of Gothenburg, Sweden.
13. Dept Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
14. Department of Physical Therapy and Occupational Therapy, Duke Diet and Fitness Center- Physical Therapy Durham, NC, United States of America.
15. Erasmus MC University, Rotterdam, The Netherlands.
16. General Internal Medicine Faculty, Madison, United States of America.
17. National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Norway.
18. Norwegian School Sport Sciences and the Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway. Statistician: Dr Rachel O’Connell- NHMRC, Clinical Trials Centre, University of Sydney, NSW, Australia.
19. Oslo University Hospital and University of Oslo, Oslo Norway