Patients report inferior quality of care for knee osteoarthritis prior to assessment for knee replacement surgery – a cross-sectional cohort study

Abstract

Purpose: To investigate 1) to which degree patients receive OA information and 2) which treatments patients with knee OA have attempted, prior to referral to an orthopaedic surgeon for an assessment of knee replacement. Methods: A cross-sectional cohort study including all patients with scheduled first-time appointments for knee OA at one Danish hospitals orthopaedic outpatient clinic from April 2017 to February 2018. Prior to their appointments with the orthopedic surgeons, patients received postal questionnaires including the OsteoArthritis Quality Indicator (OA-QI) questionnaire. The OA-QI holds 16 separate quality indicators related to patient education and information, regular provider assessments, referrals, and pharmacologic treatment of knee OA. Furthermore, questions about previous physiotherapist-delivered treatment for knee OA were asked. Results: Out of 660 eligible patients, 517 responded (78%). Responders’ mean age was 67 years and 63% were female. 128 (25%) patients had received information about OA development, 148 (29%) about possible treatment modalities, 72 (14%) about self-management and 100 (19%) about lifestyle adaptation. 247 (48%) patients felt informed about physical activity benefits, while 184 (36%) had consulted a physiotherapist due to knee problems during the past year. The physiotherapist-delivered treatments were any type of exercise therapy for 115 (22%) and participation in the Good Life with osteoArthritis in Denmark treatment concept for 61 (12%) of responding patients. Furthermore, stretching was received by 45 (9%) and massage, acupuncture and ultrasound/laser was received by 48 (9%), 37 (7%) and 24 (5%) patients, respectively. Patients may have received several treatments in combination. Paracetamol was recommended as first-line pain medication to 349 (68%) patients. Independent quality indicators were fulfilled by a mean of 32% of patients (range 8 to 74%). Sub grouped into four quality indicator categories, the percentages of fulfilled quality indicators ranged from 16 to 52% related to information, 9 to 50% related to regular provider assessment, 8 to 35% related to referrals and 16 to 74% related to pharmacological treatment. Conclusions: Patients with knee OA are undertreated in primary care. Our results call for better structure and uniform pathways for primary knee OA treatment before referral to an orthopaedic surgeon.