Objective The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best‐evidence OA care. It is important to ensure that the OACCP continues to deliver evidence‐based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritise the barriers, and generate strategies to address them. Methods This study provides a worked example of a seven‐step theory‐informed co‐design framework. We invited OACCP coordinators to participate in semi‐structured interviews (analysed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, researchers) to prioritise the barriers via a short survey (survey 2). We held five co‐design workshops where we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them. Results Sixteen coordinators were interviewed and the main barriers identified were: 1. patients often have beliefs that are inconsistent with best‐evidence care; 2. there are aspects of clinical care that are not delivered optimally; and 3. system level factors are a barrier to optimal patient care and sustainability of the OACCP. We co‐designed a plan for action with patient educational materials, shared decision‐making tools, and health professional education and training. Conclusion Our worked example of co‐design used a theory‐based, data driven approach with key stakeholders, identified and prioritised barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program. 

Building the OAChangeMap to improve the service delivery of the New South Wales Osteoarthritis Chronic Care Program: a worked example of using a co‐design framework

High-quality evidence supports exercise as a core treatment for knee osteoarthritis, improving osteoarthritis symptoms and overall health. However, most people with knee osteoarthritis are inactive and report barriers to exercise engagement. Technologies such as virtual reality (VR) may be used to improve the exercise experience and thus, promote engagement in effortful physical exercise, but clinical translation is difficult. In collaboration with knee osteoarthritis participants (n = 15) and clinicians (n = 6), we adapted a novel VR cycling system to a clinical setting (Study 1). Then, using a randomised cross-over experimental design, we evaluated the preliminary efficacy of VR cycling relative to a No-VR cycling control condition on exercise engagement, enjoyment, and pain in people with knee osteoarthritis (n = 25; Study 2). Both studies evaluated the credibility, acceptability, safety, and usability of the VR cycling system. The clinically-adapted VR cycling system resulted in greater exercise enjoyment (U = 0.82, p < 0.001) and engagement (increased time spent cycling: t24 = 2.53, p = 0.02; and greater total work t24 = 2.13, p = 0.04) than No-VR cycling. The VR cycling system was safe (no adverse events) and had high credibility and acceptability in people with knee osteoarthritis, although clinicians reported some usability/technical issues. These findings support clinical potential of the VR cycling system, although further technical refinement to maximise the usability of this technology is likely required to ensure clinician uptake. Future work to evaluate the long-term efficacy of a prolonged VR cycling intervention is warranted.

VRCycle: the clinical translation of a virtual reality cycling program to enhance exercise engagement in people with knee osteoarthritis

User Experience in Immersive Virtual Reality-Induced Hypoalgesia in Adults and Children Suffering from Pain Conditions

This year in review (1) narratively synthesises the effect of, or patient experience with, non-pharmacological or non-surgical rehabilitation treatments for osteoarthritis at any joint; and (2) describes how sex and/or gender are defined, reported, and analysed. We searched three databases (Medline, Embase, CINAHL) for studies that met predefined criteria and selected those of perceived moderate-to-high quality and importance published between 12th March 2024 and 1st March 2025. Studies were grouped according to predominant treatment topic areas (e.g. core [exercise, diet]; adjunct [electrotherapy, manual therapy]; multimodal [different rehabilitation treatments]). Two authors independently screened records. One author extracted data, and another checked 10% of the accuracy. Full-text screening identified 158 eligible studies, reduced to 39 for synthesis. We identified eight themes: i) Exercise is effective for knee osteoarthritis and comorbidities, but has varied effects for hip osteoarthritis; ii) Diet plus exercise is effective for weight loss, but may not reduce pain; iii) Digital rehabilitation is a viable alternative to in-person care; iv) No added benefit of mind/behavioural treatments; v) Effects of electrotherapy modalities on pain were inconsistent and region-specific; vi) Orthoses may relieve pain, but should be individualised to patient preferences; vii) Acupuncture and blood flow restriction treatment show effectiveness in single clinical trials; viii) Treatment packages for osteoarthritis have varied benefits. Sex and gender were reported in 23 and 11 studies, respectively. For gender, most studies used female/male/woman/man interchangeably. No study defined sex or gender, 5% reported results disaggregated by sex or gender, no study justified why results were not, and 5% summarised key sex or gender findings.

Osteoarthritis Year in Review 2025: Rehabilitation and outcomes including sex and gender reporting

Pain science education is an important component of paediatric pain care; however, access to services is limited. To disseminate pain science concepts on social media, we partnered with adolescents with chronic pain to co-design content. We engaged seven adolescent co-designers (aged 13-18 years) with lived experience of chronic pain to take part in four co-design workshops. Co-designers actively contributed to the social media campaign by selecting the social media platform, dictating design principles, generating metaphors and language, and recommending changes of mock designs. Co-designers suggested expanding the intended audience of the campaign to include people without a lived experience of chronic pain, such as friends, family, and teachers, alongside targeting adolescents with chronic pain. We published 30 posts and 102 stories over an 18-week period on Instagram, that reached over 40,000 individuals. We evaluated co-designers experience, where they reported having clear communication and necessary supports and information to participate; were able to share their ideas and felt they were heard; and felt their input was making a difference. The outputs of this campaign could be useful to guide the tailoring of other pain science education content delivered by clinicians as part of clinical care. Future testing of the content generated in this co-design process could evaluate if it leads to meaningful changes to the lives of people with chronic pain. PERSPECTIVE: Researchers partnered with adolescents with chronic pain to co-design content for a social media campaign on pain science education. Adolescent co-designers actively shaped the campaign direction, broadening its scope to reach diverse audiences. Our Instagram initiative reached over 40,000 individuals, indicating the potential for innovative educational approaches. 

Co-design and evaluation of pain science messages on social media with adolescents with a history of chronic pain.

Osteoarthritis consumers as co-researchers: Identifying consumer insights to improve osteoarthritis management by co-designing translational research solutions.

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Osteoarthritis consumers as co-researchers: Identifying consumer insights to improve osteoarthritis management by co-designing translational research solutions.