Use of non-drug non-operative interventions by community-dwelling people with hip and knee osteoarthritis

Abstract

Purpose: Guidelines recommend non-drug non-surgical treatments as the first-line approach for hip and knee osteoarthritis (OA) management, and exercise is recommended by all clinical guidelines, irrespective of disease severity, pain levels and functional status. Yet there is limited data regarding use of these treatments by people with OA. This study analyzed the treatment usage patterns in older community-dwelling adults with hip or knee OA. The primary aim was to describe the patterns of use of non-drug non-operative interventions in the entire cohort, and to compare treatment use between people with hip and knee OA, in order to identify any evidence-practice gaps that may exist in the management of OA. Methods: Four cohorts who were recruited for, and enrolled in clinical trials, completed a survey at baseline assessment. This resulted in a convenience sample of 591 people with hip or knee OA. All participants completed a questionnaire indicating their past and/or current use of 17 non-drug, non-operative interventions each for their hip or knee OA. Each intervention was classified according to the American College of Rheumatology (ACR) clinical guideline recommendations as being “strongly recommended”, “conditionally recommended” or “no recommendation” for people with hip and/or knee OA to aid in interpretation of our findings. Descriptive analyses, based on frequency counts and proportions, and chi square tests described the use of each intervention in the total cohort, and within subgroups of knee and hip OA. Results: The most common strategy that participants reported having tried was making efforts to lose weight (n=367, 62% of the entire cohort). Of the other three interventions strongly recommended by the ACR less than half of the cohort reported having tried each (muscle strengthening= 44%, hydrotherapy= 21% and aerobic exercise= 21%). Of note, 46% of the cohort reported having tried stretching exercises, which has no recommendations from the ACR. Receiving counselling over the phone was the intervention least commonly tried by our cohort (<1%). Of the entire cohort 12% (n=71) had never used any of the 17 surveyed interventions. Fewer people with hip OA had tried conservative non-drug treatments for their condition compared to those with knee OA. A significantly greater proportion of participants with knee OA reported having tried shoe orthoses (42% compared with 30% of hip OA); heat and/or cold treatment (43% versus 23%); muscle strengthening exercises (46% versus 32%); walking aids (15% versus 7%) and; transcutaneous electrical nerve stimulation (57% versus 4%). Conclusions: Use of non-drug non-operative interventions was low amongst people with hip and/or knee OA. In our sample, it appears that people with knee OA are more likely to try non-drug non-operative treatments than those with hip OA, however no explanation for this difference is obvious in this cohort. Our findings show evidence-practice gaps, particularly with respect to the interventions most strongly recommended in clinical guidelines for hip and knee OA (weight loss and exercise). Efforts to maximize the uptake of the strategies most strongly endorsed by research and guidelines are recommended.