Health professional consultation and use of conservative management strategies in patients with knee or hip osteoarthritis awaiting orthopaedic consultation
Robin Haskins A C , Judith M. Henderson A and Nikolai Bogduk BA Royal Newcastle Centre, Locked Bag 664J, Newcastle, NSW 2300, Australia.
B Newcastle Bone and Joint Institute, Locked Bag 664J, Newcastle, NSW 2300, Australia.
C Corresponding author. Email: Robin.Haskins@hnehealth.nsw.gov.au
Australian Journal of Primary Health 20(3) 305-310 https://doi.org/10.1071/PY13064
Submitted: 7 February 2013 Accepted: 17 June 2013 Published: 18 July 2013
Abstract
The aim of this study was to determine the extent to which patients with hip and knee osteoarthritis (OA) referred for orthopaedic consultation at a large Australian public hospital reported using conservative management strategies as recommended by current practice guidelines. A therapist-assisted questionnaire was employed within the context of a standard physiotherapy assessment in a consecutive cohort of patients with hip or knee OA. Two hundred and two patients with hip or knee OA comprised the included sample. Thirty-nine percent (n = 79) reported having only previously consulted their general practitioner. Only 20% (n = 41) felt that they had been sufficiently educated about the diagnosis, their treatment options and prognosis. Thirty-three percent (n = 66) had not previously engaged in any non-pharmacological management strategy considered a core clinical practice guideline recommendation. The findings of this study suggest that several inconsistencies may exist between current Australian clinical practice and OA clinical guideline recommendations. Identification of the barriers to the use of conservative management requires timely investigation coupled with a national implementation framework to support the translation of guideline recommendations into practice.
References
Access Economics (2007) Painful realities: the economic impact of arthritis in Australia in 2007. Arthritis Australia, Sydney.Ackerman I (2006) The pre-operative status of people undergoing primary total hip and knee replacement surgery. PhD thesis. The University of Melbourne.
Agresti A, Coull BA (1998) Approximate is better than ‘exact’ for interval estimation of binomial proportions. The American Statistician 52, 119–126.
American Academy of Orthopaedic Surgeons (2008) ‘Treatment of osteoarthritis of the knee (non-arthroplasty).’ (AAOS: Rosemont, IL)
Australian Bureau of Statistics (2010) 2007–2008 National Health Survey: summary of results (reissue). Cat. no. 4364.0. ABS, Canberra.
Beadle C, Howie CR, Nuki G (2010) OARSI recommendations for the management of hip and knee osteoarthritis: which treatments are being used? Audit of patients coming to arthroplasty in Scotland. Osteoarthritis and Cartilage 18, S152
| OARSI recommendations for the management of hip and knee osteoarthritis: which treatments are being used? Audit of patients coming to arthroplasty in Scotland.Crossref | GoogleScholarGoogle Scholar |
Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A (2007) The burden of disease and injury in Australia 2003. PHE 82. AIHW, Canberra.
Bopf D, McAuliffe M, Shillington M, Drynan D, Bucknell E (2010) Knee osteoarthritis: use of investigations and non-operative management in the Australian primary care setting. Australasian Medical Journal 1, 194–197.
Brand C (2007) Translating evidence into practice for people with osteoarthritis of the hip and knee. Clinical Rheumatology 26, 1411–1420.
| Translating evidence into practice for people with osteoarthritis of the hip and knee.Crossref | GoogleScholarGoogle Scholar | 17483981PubMed |
Brand C, Osborne RH, Landgren F, Morgan M (2007) ‘Referral for joint replacement. A management guide for health providers.’ (RACGP: Melbourne)
Brand C, Hunter D, Hinman R, March L, Osborne R, Bennell K (2011) Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia? International Journal of Rheumatic Diseases 14, 181–190.
| Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia?Crossref | GoogleScholarGoogle Scholar | 21518318PubMed |
Britt H, Miller G, Charles J, Henderson J, Bayram C, Valenti L, Pan Y, Harrison C, O’Halloran J, Fahridin S, Chambers T (2010) General practice activity in Australia 2001–01 to 2009–10: 10 year data tables. General practice series no. 28. Cat. no. GEP 28. AIHW, Canberra.
Broadbent J, Maisey S, Holland R, Steel N (2008) Recorded quality of primary care for osteoarthritis: an observational study. The British Journal of General Practice 58, 839–843.
| Recorded quality of primary care for osteoarthritis: an observational study.Crossref | GoogleScholarGoogle Scholar | 19068156PubMed |
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. Journal of the American Medical Association 282, 1458–1465.
| Why don’t physicians follow clinical practice guidelines? A framework for improvement.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FgsVSqtw%3D%3D&md5=784fde785d793b5a43fa459e7e423d95CAS | 10535437PubMed |
Christensen R, Bartels EM, Astrup A, Bliddal H (2007) Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Annals of the Rheumatic Diseases 66, 433–439.
| Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 17204567PubMed |
Denoeud L, Mazieres B, Payen-Champenois C, Ravaud P (2005) First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence. Annals of the Rheumatic Diseases 64, 70–74.
| First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M%2FgslKgtA%3D%3D&md5=71f1e9228f020135fd668df9c0a3ec7bCAS | 15608302PubMed |
Dieppe P, Lim K, Lohmander S (2011) Who should have knee joint replacement surgery for osteoarthritis? International Journal of Rheumatic Diseases 14, 175–180.
| Who should have knee joint replacement surgery for osteoarthritis?Crossref | GoogleScholarGoogle Scholar | 21518317PubMed |
Egger G, Donovan R, Swinburn B, Giles-Corti B, Bull F (1999) Physical activity guidelines for Australians − scientific background report. Commonwealth Department of Health and Aged Care, Canberra.
Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care and Research 64, 465–474.
| American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XotVSmsLk%3D&md5=5f8a4b01880dec19ec3f7b852f3f04e1CAS | 22563589PubMed |
Howarth D, Inman D, Lingard E, McCaskie A, Gerrand C (2010) Barriers to weight loss in obese patients with knee osteoarthritis. Annals of the Royal College of Surgeons of England 92, 338–340.
| Barriers to weight loss in obese patients with knee osteoarthritis.Crossref | GoogleScholarGoogle Scholar | 20385042PubMed |
Hunter DJ (2011) Lower extremity osteoarthritis management needs a paradigm shift. British Journal of Sports Medicine 45, 283–288.
| Lower extremity osteoarthritis management needs a paradigm shift.Crossref | GoogleScholarGoogle Scholar | 21297174PubMed |
Hunter DJ, Eckstein F (2009) Exercise and osteoarthritis. Journal of Anatomy 214, 197–207.
| Exercise and osteoarthritis.Crossref | GoogleScholarGoogle Scholar | 19207981PubMed |
Hunter DJ, Lo GH (2008) The management of osteoarthritis: an overview and call to appropriate conservative treatment. Rheumatic Diseases Clinics of North America 34, 689–712.
| The management of osteoarthritis: an overview and call to appropriate conservative treatment.Crossref | GoogleScholarGoogle Scholar | 18687278PubMed |
Hunter DJ, Neogi T, Hochberg MC (2011) Quality of osteoarthritis management and the need for reform in the US. Arthritis Care and Research 63, 31–38.
| Quality of osteoarthritis management and the need for reform in the US.Crossref | GoogleScholarGoogle Scholar | 20583113PubMed |
Kane R, Saleh K, Wilt T, Bershadsky B, Cross WI, MacDonald R, Rutks I (2003) Total knee replacement. Evidence Report/Technology Assessment No. 86 (prepared by the Minnesota Evidence-based Practice Centre, Minneapolis, MN). AHRQ Publication No. 04-E006-2. Agency for Healthcare Research and Quality, Rockville, MD.
National Health and Medical Research Council (2003) Clinical practice guidelines for the management of overweight and obesity in adults. Commonwealth of Australia, Canberra.
National Institute for Health and Clinical Excellence (2008) Osteoarthritis. The care and management of osteoarthritis in adults. NICE, London.
New South Wales Agency for Clinical Innovation Musculoskeletal Network (2012) ‘Osteoarthritis chronic care program model of care. Executive summary.’ Available at http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/165315/Executive-Summary.pdf [Verified 25 June 2013]
Rosemann T, Wensing M, Joest K, Backenstrass M, Mahler C, Szecsenyi J (2006) Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses. BMC Musculoskeletal Disorders 7, 48
| Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses.Crossref | GoogleScholarGoogle Scholar | 16749935PubMed |
Royal Australian College of General Practitioners (2009) ‘Guideline for the non-surgical management of hip and knee osteoarthritis.’ (RACGP: Melbourne)
Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Marcolongo R (2005) Do physicians treat symptomatic osteoarthritis patients properly? Results of the AMICA experience. Seminars in Arthritis and Rheumatism 35, 38–42.
| Do physicians treat symptomatic osteoarthritis patients properly? Results of the AMICA experience.Crossref | GoogleScholarGoogle Scholar | 16084232PubMed |
Turner AP, Barlow JH, Buszewicz M, Atkinson A, Rait G (2007) Beliefs about the causes of osteoarthritis among primary care patients. Arthritis and Rheumatism 57, 267–271.
| Beliefs about the causes of osteoarthritis among primary care patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s7psFGgsA%3D%3D&md5=f46bbf8d7a1f20f4e660af77c743ce16CAS | 17330306PubMed |
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis. Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage 16, 137–162.
| OARSI recommendations for the management of hip and knee osteoarthritis. Part II: OARSI evidence-based, expert consensus guidelines.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c7it12itg%3D%3D&md5=a4e7373f43df017d9473dd62c7c81d5dCAS | 18279766PubMed |