SAT0728-HPR REVISION OF THE DUTCH GUIDELINE FOR PHYSIOTHERAPY IN PATIENTS WITH HIP AND KNEE OSTEOARTHRITIS: RECOMMENDATIONS FOR DAILY PRACTICE

Abstract

Background Until 2018, the most recent update of the Dutch physiotherapy guideline for Hip and Knee Osteoarthritis (HKOA) was conducted in 2010. Since then, scientific developments changed the view on osteoarthritis and could have significant impact on daily practice. An update of the guideline was necessary with more applicable recommendations about the content of exercise therapy. Objectives To revise the Dutch guideline for physiotherapists in patients with HKOA Methods To develop more practical and widely supported guidelines, a guideline methodology was developed by the Royal Dutch Society for Physical Therapy (KNGF) in 2016. This methodology was based on GRADE, the most accepted approach in guideline development worldwide. According to the KNGF methodology, a guideline panel was formed out of 22 stakeholders, e.g. physiotherapists, general practitioners, orthopedic surgeons, patient representatives and healthcare insurers. Based on the scientific evidence and other considerations, the guideline panel formulated the recommendations in this guideline. Results Recommendations about diagnostics and therapeutic interventions formed the base of the new Dutch physiotherapy guideline for HKOA. Three indications were formulated, based on patient preferences, severity of the functional condition and existence of comorbidity. A fourth indication concerned pre- and postoperative physical therapy before or after a total joint replacement. It was recommended to restrict physical therapy in patients with minor functional limitations by informing and advising about osteoarthritis and how to deal with the disease. In contrast, extensive supervised exercise therapy was recommended in patients with severe functional restrictions and/or comorbidity. Besides informing and advising, supervised exercise therapy is stated as the intervention with the strongest recommendation. Frequency, Intensity, Type and Time (FITT factors) of exercise therapy are described extensively, based on evidence and strongly linked to (inter)national recommendation for physical activity. Besides informing and advising, other non-exercise therapeutic interventions were not recommended. Conclusion The new physiotherapy guideline for HKOA provides practical information and guidance to physiotherapists on diagnostics and therapeutic interventions. Extensive implementation is necessary to enhance conservative treatment of osteoarthritis and achieve uniform health care. Reference [1] Rausch, et al. EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018 Sep;77(9):1251-1260. Disclosure of Interests None declared