Osteoarthritis: Conservative therapy delays need for joint replacement surgery
"It is wise to consider
all non-surgical treatment options before resorting to an artificial
hip or knee joint implant," said EULAR President Professor Iain B.
McInnes, University of Glasgow, Scotland. Yet in many cases, doctors and
patients fail to exhaust the full range of conservative therapy
options. A Norwegian study has now shown how many patients with
osteoarthritis (OA) can benefit from a qualified, conservative therapy
programme.
The study design, a
so-called cluster-randomised trial (CRT), comprised a programme
developed based on international treatment recommendations for hip and
knee osteoarthritis (OA). It included an initial three-hour patient
education programme, among other things. This was followed by 8-12 weeks
of individually tailored exercises supervised by physiotherapists. The
programme was facilitated by general practitioners, primary care
physicians and physiotherapists, who also received prior training. A
total of 393 patients participated in the study; 284 were included in
the special osteoarthritis programme and 109 (control group) continued
their usual care. The participants were at least 45 years old and
presented with clinical OA symptoms such as reduced mobility or pain.
They were re-examined 12 months after the beginning of the programme.
The study parameters included but were not limited to quality of care,
satisfaction with care, physical activity, and referrals to
physiotherapy or orthopaedic surgeons. The researchers also recorded
whether joint replacement surgery was performed.
"The implementation of a structured model for OA care led to an improved quality of care, higher patient satisfaction and increased physical activity, despite OA," stated co-author of the study Tuva Moseng, Diakonhjemmet Hospital, Oslo, Norway. There is also some evidence to suggest that a structured OA programme including patient education and exercise may delay or even reduce the need for surgery after 12 months.
Professor John Isaacs from Newcastle University, UK, and Chair of the EULAR 2020 Scientific Programme Committee summarised: "Once again, we see just how important and effective consistent, conservative therapy is for our OA patients." He urged that "conservative care based on the international recommendations for OA treatment should become the standard for all patients."