Evaluation of large-scale implementation of self-management NICE guidelines of Osteoarthritis within Primary Care

Large-scale Sustainable Change
Implementation, at scale, of a model to support NICE Guidelines for the management of Osteoarthritis (OA) in primary care

What we know

Osteoarthritis (OA) is one of the leading causes of disability in Scotland which impacts on patients’ quality of life, work and the wider society.

Primary care services deal with high-volume demand but there is duplication across primary care, orthopaedic and allied health professional services.  Delay in appropriate advice and treatment for people with OA can result in prolonged pain and disability.

Project aim

This project will investigate the feasibility of implementing a model of care recommended in national guidelines, as part of the JIGSAW-E (Joint Implementation of osteoarthritis guidelines across Western Europe) approach.  JIGSAW-E aims to implement a real-world primary care approach to improve the quality of care and support for the self-management for osteoarthritis. 

It is intended that the JIGSAW-E training model will be used by advanced practice physiotherapists to improve educational and skill levels of health professionals in the care of people with osteoarthritis.  In the future this could impact directly on the health of people with osteoarthritis in the community.

What this research explored

In this study we aimed to explore the feasibility of implementing an evidence-based model (JIGSAW-E) to improve self-management for people with osteoarthritis in Scottish primary care.

Phase 1: We reached our target and recruited 10 practices across Scotland from Lothians, Ayrshire and Arran, the Highlands, Forth Valley and Lanarkshire. Initially, we aimed to complete 20 interviews, however, due to saturation of the data we recruited 14 participants for interview and invited other stakeholders to attend a workshop (detailed in Phase 2).

Phase 2: Following on from the interviews, we organized a knowledge mobilisation /training workshop, which included collaborators from the JIGSAW-E team at Keele University. Discussion focused on key themes arising from the interviews, and issues around engagement support for implementation of the model. This impacted on the health professionals’ knowledge directly, but we did not assess the change in behaviour or skills.

What this study adds

Through networking and collaboration with clinicians working in primary and secondary care; this project has raised awareness of the JIGSAW-E online training resource and has resulted in increased knowledge of the role of the health professional (as stated in the research proposal).

We identified staff to train and roll out the training across ESP national networks; which has resulted in 20+ health care practitioners completing a 3-hour training workshop. In addition to this training, an online teaching module is now available: https://jigsaw-e.com/courses/joint-pain-in-physiotherapy/

Knowledge has been disseminated through planned workshops, peer-reviewed publications at EULAR but also through other knowledge exchange activities with the local community and core partners who are already delivering the JIGSAW-E model in England and Europe.

Benefits and impact

This study has resulted in a range of benefits and impact – from the practice change, to future collaboration and opportunities to increase self-management.   

Practice Change:

  • Through collaboration with clinical networks and PPI the team has built engagement and capability across a network of researchers and practitioners helping to disseminate the JIGSAW-E model in primary care to support national improvement in Scotland’s health and care.
  • Training of physiotherapy advanced practice physiotherapists has the potential to shift the balance of care in primary care, from GPs to advanced practice physiotherapists, through the increased awareness of the JIGSAW training in Scotland. Ultimately impacting on health and quality of life for people living with OA.
  • This study has disseminated the improvement science knowledge base to practitioners through a knowledge exchange event and facilitated translation of improvement knowledge into practice.


  • This study has built capacity with local health professionals (advanced practice physiotherapists) in Scotland and led to collaboration with an international group (The International Joint Effort Initiative Implementation Working Group for Osteoarthritis).
  • Increase collaborative working between England (Keele University ) and Scotland (ENU) universities through knowledge exchange and continuing to work together in development of training material e.g. development of video/ patient guidebook.


  • Based on our research outcomes from the JIGSAW project we have found that a guidebook, developed for patients with OA, needs to be adapted for the Scottish Context https://jigsaw-e.com/patient-focus/guidebook/. Modification and distribution of the OA Guidebook either in leaflet format or video could impact on the health of people with osteoarthritis in the community.
  • As a result of this project, an application for public engagement has been successful enabling a two phased approach to raise public awareness – which will be conducted after the COVID-19 pandemic:
    • Phase One: co-produce with a small group of public and third sector stakeholders, adaptations to the guidebook for circulation in community centres.
    • Phase two: host two workshops in collaboration with B Healthy Together; to raise awareness of what arthritis is and how to improve quality of life for those living with it. This will include a positive focus on self-management and physical activity.  

Online JIGSAW training

The JIGSAW training material is available now on the JIGSAW-E website and free to all NHS health professionals.  Participants are asked to register on the site to monitor impact. 


The project was led by Dr Helen Frost, supported by colleagues from the School of Health and Social Care at Edinburgh Napier University and the JIGSAW-E team at Keele University; in conjunction with primary care colleagues from NHS Lothian and Advanced Practitioners from across NHS Scotland. 

For more information please contact SISCC (siscc@dundee.ac.uk)


JIGSAW-E  Supported self-management for joint pain