Can Digitally Delivered First-line Osteoarthritis Treatment Improve Equal Access to Care in Urban and Rural Areas of Sweden

Since 2008 Sweden has had a structured first-line face-to-face knee and hip osteoarthritis (OA) treatment program, Better management of patients with OsteoArthritis (BOA). However, records show that this face-to-face program is underutilized and reaches only a minority of those that would benefit from it.

The first-line OA management program has been transformed into a digital version, Joint Academy® (JA), to facilitate implementation, scaling, increased accessibility, and improved patient adherence. The mobile application (app) consists of video instructions distributed daily with individualized exercises for participants with knee or hip OA, as well as educational information on OA symptoms and self-management based on current international guidelines for the management of OA. Each participant is assigned to a physical therapist available through asynchronous chat and telephone who supervises the participant throughout the whole program.

To improve chronically ill patients' health and quality of life, long-standing and continuous treatment is needed at an acceptable cost. Recent evidence suggests that JA costs 25% compared to the BOA program for three months of treatment. Providing patients with equal access to care necessitates availability in urban and rural areas alike. This can potentially be achieved by digital delivery, but it is yet unknown if digital delivery of first-line OA treatment, compared with face-to-face, improves equal access to care. The purpose of this study was to compare utilization of digital and face-to-face delivered OA treatment in the 21 different county councils of Sweden that are responsible for providing healthcare to the residents.

Method Registered patient participation in the BOA program during 2021-2023 will be retrieved from the BOA Register. The BOA registry. Data from digital program participation was retrieved from the JA database. To be included, a patient need to have registered for the first visit in the BOA registry or have enrolled in the program by answering the first questionnaire in the JA registry.

Population density per county and county size were retrieved from Statistics Sweden. Results were calculated and presented as users per 100 000 residents. Mean and median values as well as standard deviations were calculated separately for registered participants/100 000 for BOA and JA programs, and for regions with more (n=12) or less (n=8) than 20 residents per km2.