Knee and Hip Osteoarthritis Integrative Care in an Academic Medicine Pain Center: A Clinical Case Series During COVID-19

Objectives: The goal of the prospective study was to understand changes in pain and function among patients with knee or hip osteoarthritis (OA) in an integrative pain center. Little is known about how integrative health treatments interact with mainstream medical treatments for knee or hip osteoarthritis. Our clinical case series describes the outcomes of 42 patients diagnosed with knee or hip osteoarthritis who were assessed in the Comprehensive Pain Center at Oregon Health & Science University from July 2020 to July 2022 during the onset of the COVID-19 pandemic. Methods: Most patient visits shifted to virtual appointments due to COVID-19. As part of usual care during COVID-19, patients received virtual visits with pain providers and health psychologists. In addition, in-person visits for acupuncture, chiropractic, massage, and Rolfing were available. Patient-reported outcomes were collected via phone and stored in REDCap Cloud prior to visits. A multipronged data-gathering approach was implemented with REDCap Cloud, including questionnaires obtained over the telephone and in person with iPads using a QR code for participant identification. Results: There were 34 females and 8 males with a median age of 63.1 (range: 34–78) with an average of 11 clinic visits. Their initial PROMIS Global physical mean score was 33.9, and mental was 38.7. At 12 months, mean outcomes were improved among 17 patients who provided follow-up data on the Hip Dysfunction and Osteoarthritis Outcome Score, Knee Dysfunction and Osteoarthritis Outcome Score, and Brief Pain Inventory. Conclusions: With patient care shifted to virtual appointments, data collection was challenging. Although one cannot infer causality from a case series, some patients seeking integrative care for osteoarthritis trended towards improved outcomes despite difficulties due to widespread treatment disruption with COVID-19.