A mixed-methods first-year evaluation of implementation outcomes for a bottom-up osteoarthritis management program across healthcare settings in Ireland

Background: The Good Life with osteoArthritis Denmark (GLA:D®) non-profit initiative is a bottom-up approach to deliver evidence-based care, including exercise and education, to people with hip or knee osteoarthritis. GLA:D® was adapted for public and private healthcare in Ireland, using a participatory approach to co-design implementation strategies that would ensure optimal and equitable access. Purpose: To evaluate implementation outcomes of acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration and sustainability of GLA:D® Ireland across healthcare settings, in the first year. Methods: Mixed methods explanatory sequential design. GLA:D® training was advertised to physiotherapists in different healthcare settings around Ireland. Quantitative implementation outcomes were collected from the GLA:D® Ireland Registry. Semi-structured interviews were conducted with trained physiotherapists and participants and analyzed to identify themes. Results: In the first year, 32% of the 71 physiotherapists trained implemented GLA:D® in practice (n = 10 primary care, n = 2 public hospital, n = 3 private). Of 146 participants, 41% were from three sites with ≥1 physiotherapist trained. In interviews (10 physiotherapists, 9 participants), satisfaction with the structured nature that allowed individualization and self-management was reported. Physiotherapists used the program to tackle long waitlists and participants regained confidence to exercise. While equipment costs were low, more staffing and space were mediators for feasibility and sustainability across settings. Conclusions: While a high proportion of GLA:D® adopters were in primary care settings, penetration was more successful in public hospitals, with more resources and physiotherapists trained per site. Results suggest that implementation strategies could be adapted to incentivize training of multiple staff at one site and training of support staff. Top-down funding would help to ensure timely and equitable access to the program across healthcare settings.