Impact of educational level and employment status on short-term and long-term pain relief from supervised exercise therapy and education: an observational study of 22 588 patients with knee and hip osteoarthritis

OBJECTIVES: To investigate the impact of educational level and employment status on change in pain intensity after treatment among patients with knee and hip osteoarthritis (OA).

DESIGN: A prospective cohort study.

SETTING AND PARTICIPANTS: We analysed 22 588 patients participating in the Good Life with osteoArthritis in Denmark (GLA:D). GLA:D consists of two patient education sessions and 12 supervised exercise sessions.

PRIMARY OUTCOME: Baseline educational level and employment status were used as exposures. We investigated the impact of both exposures separately on mean change in pain intensity (visual analogue scale 0-100 mm) from baseline to immediately after treatment (approximately 3 months) and at 12 months, using linear mixed models.

RESULTS: On average, all patients improved in pain intensity. The average improvement in pain did not differ by educational level, except for one group. Patients with long-term education had less improvement after treatment (2.0 mm, 95% CI 0.8 to 3.1) and at 12 months (2.0 mm, 95% CI 0.6 to 3.4) compared with primary school only (reference). According to employment status, patients on sick leave had the greatest improvement in pain after treatment (-3.4, 95% CI -4.9 to -1.9) and at 12 months (-4.5, 95% CI -6.4 to -2.6) compared with retired patients (reference).

CONCLUSIONS: On average, all patients reported improvement in pain at short-term and long-term follow-up. Change in pain intensity did not substantially differ by educational level or employment status, as the absolute differences were small and most likely not clinically important.