GLA:D® was developed by two researchers, Professor Ewa Roos and Professor Soren Skou in 2013, following 3 years of unsuccessful discussions with healthcare administrators in Denmark to bridge the gap between available treatment guidelines and clinical practice. They aimed to increase awareness of the GLA:D® programme in patients with osteoarthritis and other stakeholders through nationwide media attention. Six years after inception, more than 1000 clinicians have been certified via a 2-day course. These clinicians offer the programme to more than 400 clinics nationwide and have treated more than 45 000 patients. Patient data collected in an electronic database at baseline, following the intervention and at 1 year, showed pain relief, improved walking speed, reduced use of analgesia, number of days on sick leave and helped change the reimbursement system for physiotherapy in one of the five Danish healthcare regions in 2017. GLA:D®’s success has also raised general awareness of osteoarthritis among the community, along with knowledge that patient education and exercise theapy are an effective solution.
In 2015, following the success of GLA:D® in Denmark, a group of researchers in Canada translated the programme content, and with the help of the Programme’s developers, conducted a feasibility study of the GLA:D® Program demonstrating its feasibility in the Canadian context. The results of the feasibility study were at least as good as those in Denmark, with patients (n=58) averaging a 40% reduction in pain, as well as significantly improving their function, quality of life and physical activity. Since launching the program in January 2016, Bone and Joint Canada has hosted training sessions in six provinces. Healthcare professionals with scope of practice to prescribe and progress exercise for people with chronic conditions, including physiotherapists, kinesiologists and chiropractors, have been trained to deliver GLA:D® in Canada. The programme has been implemented in private and public healthcare centres in 8 of the 13 provinces/territories. The GLA:D® team continue to disseminate the programme nationally for people across the spectrum of osteoarthritis severity, including working with policy makers to align the programme with the provincial strategies for access to hip and knee replacement.
At the end of 2016, the team at La Trobe Sports and Exercise Medicine Research Centre hosted the first GLA:D® training course in the southern hemisphere for physiotherapists. The GLA:D® Programme was then implemented in 2017, and to date almost 1,000 clinicians have been trained, across every state and territory of Australia. The clinician-researchers overseeing GLA:D® Australia are developing contemporary knowledge translation resources including social media strategies, infographics, YouTube videos of exercise and education, and patient and clinician websites to complement the GLA:D® Programme. Resources are based on identified knowledge gaps and needs of patients and clinicians, and aim to further enhance awareness about the importance of education and exercise as the primary treatment for hip and knee pain in Australia and internationally.
In 2017, GLA:D® China was initiated by orthopaedic surgeons from Peking University People’s Hospital with funding from Beijing Joint Care Foundation. The GLA:D® Programme has been successfully delivered at the Department of Orthopaedics at a large general hospital and in a traditional community hospital. An electronic survey and a social media application are used to collect outcome data and patients’ feedback. The first 147 patients reported 40% pain reduction on average, and experienced improved physical function. To scale up GLA:D® across China, Peking University reached an agreement on a co-financed research collaboration with the University of Southern Denmark. The first GLA:D® course in China was held in September 2017 and certified nine orthopaedic surgeons, five nurses and two physiotherapists.
The international success of the GLA:D® Programme has resulted in more countries coming on board, with Switzerland initiating the program in November 2018, where it is hosted by a group of leading local researchers and practitioners. Since May 2019 physiotherapists in Switzerland have been delivering the program to patients.
The next country planning on implementing the GLA:D® Programme is New Zealand, with a group of local researchers and clinicians aiming to have the program up and running by 2020. Prof Ewa Roos, the program’s developer from Denmark, and Dr Christian Barton, GLA:D® Australia’s Project Lead, will be training New Zealand physiotherapists in November 2019.