Outcomes of a structured exercise and education program for hip and knee osteoarthritis across different clinical and geographic settings in Australia: A cohort study of 9,938 participants

Objective: In Australia, the Good Life with osteoArthritis from Denmark (GLA:D®) program is delivered across different settings. This study compared 3-month outcomes by clinic setting (public vs private), geographic location (rural/remote vs metropolitan), and education level among participants with hip and knee osteoarthritis. Design: This longitudinal registry-based cohort study used GLA:D® Australia registry data for participants enrolled between December 2017 and August 2025. Outcomes included pain, self-reported function, joint-and health-related quality of life, and physical function. Changes were estimated using mixed-effects linear regression. Results: Of 14,803 participants with baseline data, 9938 (67.1%) were included in complete-case analysis. About 74% attended metropolitan clinics, 84% attended private practices, and 44% had a university degree.At 3-months, participants with knee osteoarthritis attending private clinics had greater improvements compared to those attending public clinics, including pain (worst pain mean difference = -4.8 [95% confidence interval = -6.4 to -3.2]), Knee injury and Osteoarthritis Outcome Score (KOOS-12) total (1.7 [0.7 to 2.6]) and KOOS-12 pain subscale scores (2.0 [1.0 to 3.1]). Outcomes did not differ between public and private clinics for hip osteoarthritis, nor by geographical location or education level for hip or knee osteoarthritis. Conclusions: Three-month improvements across all examined groups indicate that GLA:D® can deliver benefits in a wide range of settings, without statistically significant differences across geographic location or education level. Participants with knee osteoarthritis attending private clinics showed slightly better outcomes than those in public clinics, though the differences were small and likely not clinically meaningful.