Osteoarthritis Guidelines Research Articles

OTC Analgesics vs Opioids for Pain Management.

The use of opioids in acute pain may be appropriate in some situations, but there are opportunities to reduce exposure to opioids with equally effective monotherapy and combination therapy over-thecounter (OTC) medications. There are a number of OTC analgesics that are readily accessible and costeffective options to treat pain. The American College of Rheumatology Osteoarthritis Guideline "strongly" recommends the use of topical nonsteroidal antiinflammatory drugs (NSAIDs) and oral NSAIDs to treat arthritis pain, and it conditionally recommends against the use of opioids (other than tramadol). The American Headache Society suggests that OTC NSAIDs and combination medications such as acetaminophen, aspirin, and caffeine are Level A recommendations for reducing migraine pain and other symptoms. Nonopioid OTC analgesics, such as NSAIDs and the NSAID/acetaminophen combination, are safe and effective firstline options for managing acute dental pain according to the American Dental Association. The American College of Physicians supports the use of NSAIDs as first-line therapy for the treatment of low back pain.

Clinical and economic aspects of chondroitin sulfate in osteoarthritis management: a brief review of recent evidence

Introduction: Chondroitin sulfate was proposed as a more appropriate strategy for osteoarthritis long-term management than conventional treatment (nonsteroidal anti-inflammatory drugs and acetaminophen). However, its efficacy has been widely discussed and its public financing by the Spanish National Health System has been questioned. The aim of this paper was review on the clinical and economic aspects of chondroitin sulfate in osteoarthritis treatment.
 Method: A bibliographic search of recent literature was carried out until March 9th, 2022. The databases used were MEDLINE and Scopus.
 Results: According to the set of clinical studies identified in the search, chondroitin sulfate was effective in reducing cartilage volume loss, its clinical effects were estimated by objective (magnetic resonance or specific biomarkers) and subjective (visual analog pain scale or Lequesne index) outcome measures. In the set of studies reviewed, chondroitin sulfate proved to be an acceptable therapeutic option in clinical terms. Regarding economic aspects, only one study was identified, according to which, the prescription of chondroitin sulfate implies a lower cost per patient compared to non-steroidal anti-inflammatory drugs.
 Conclusion: From the clinical and economic points of view, the findings of this brief review justify the presence of chondroitin sulfate in osteoarthritis guidelines.

Physical Therapists Prioritize Providing Education About Exercise Therapy and to Dispel Misconceptions About Radiology for People With Knee Osteoarthritis: A Concept Mapping Study.

To (1) identify the education priorities that physical therapists have for people with knee osteoarthritis, including perceived importance and capability to provide, and (2) match priorities to education-specific content recommendations in knee osteoarthritis guidelines. Concept mapping methodology. Physical therapists generated, sorted (based on themes), and rated (5-point Likert scales: importance and capability) patient education priorities. Priorities were matched against education-specific content recommendations in knee osteoarthritis guidelines. Additional education-specific content recommendations were added from guidelines and expert opinion if necessary. Multidimensional scaling and hierarchical cluster analysis produced a cluster map with overarching domains. Physical therapists (brainstorming, n = 41; sorting, n = 20; rating, n = 22) generated 56 priorities, with 13 added (n = 2 from guidelines, n = 11 from expert opinion). Few priorities were clearly included as education-specific content recommendations in guidelines (ACR [2%, n = 1/56], EULAR [14%, 8/56], NICE [11%, 6/56], and OARSI [0%, 0/56]). An 8-cluster map emerged with 3 overarching domains: (i) first-line care (exercise therapy, lifestyle modification and general health, and weight management), (ii) knowledge formation and countering misconceptions (radiology misconceptions, understanding and managing pain and disability, and general beliefs and understanding about osteoarthritis), and (iii) decision making for medical management (surgery and medications). The exercise therapy cluster was rated the highest for both importance (3.84/5) and capability (4.00). The medications and weight management clusters were rated the lowest for importance (2.54) and capability (2.82), respectively. Physical therapists prioritize a range of education topics for people with knee osteoarthritis, focusing on exercise therapy. Physical therapists feel least capable of providing weight management education. J Orthop Sports Phys Ther 2022;52(9):607-619. Epub: 17 June 2022. doi:10.2519/jospt.2022.11090.

Implementation of clinical guidelines for osteoarthritis together (IMPACT): project protocol for a participatory health research approach to implementing high value care

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Practice guidelines for the treatment of acute migraine and chronic knee osteoarthritis with paracetamol: an expert appraisal on evolution over time between scientific societies

Background: Paracetamol is the commonest analgesic worldwide in primary care. Despite evidence-based recommendations for management of acute and chronic pain with paracetamol, practices seem vary considerably in its modalities of use, with or without restrictions, between renowned scientific societies and over time. Objective: Qualitative assessment of similarities, differences, and changes over time in guidelines for paracetamol use in acute and chronic pain. Methods: We focused on two common pain conditions for which paracetamol is widely used: acute migraine and chronic knee osteoarthritis (OA). In 19 guidelines (10 for acute migraine, 9 for chronic knee OA) from 10 scientific societies (AAN/AHS, ACR/AF, CHS, EFNS, EHF/LTB, ESCEO, EULAR, SFEMC, SRF, OARSI) published between 1997 and 2021, methods, results and conclusions were compared, between guidelines and over time. Results: In acute migraine, there was a shift from no recommendation for paracetamol or recommendation only for mild attacks to recommendation for mild to moderate attacks in updated guidelines, without restriction for use for four of the five scientific societies. In knee OA, although updated guidelines generally used the GRADE system, recommendations remained heterogeneous between scientific societies: recommendation without or with restrictions, or not recommended. Consensus is lacking regarding long-course safety and efficacy in acute pain and pain at mobilization. Conclusions: Most migraine guidelines now recommend paracetamol for mild to moderate pain. Knee OA guidelines vary on the use of paracetamol: a more holistic approach is needed for this condition, considering patient profile, disease stage, and pain management during physical activity to clarify its appropriate use.

The non-operative management of primary osteoarthritis.

Osteoarthritis is a syndrome characterised by joint pain, resulting in functional limitation and a decreased quality of life. This chronic condition is one of the major public health problems facing society today and is likely to become more prevalent. The expected increase is because of the primary causative factors, advancing age and obesity, becoming increasingly prevalent in society. The diagnosis of osteoarthritis can be made clinically when activity related joint pain is present, alongside morning joint stiffness that lasts for less than 30 minutes. However, a radiological diagnosis can also be made. This article examines the current management strategies, as outlined by the National Institute for Health and Care Excellence guidelines for osteoarthritis. Although numerous surgical options are available, this article focuses on the non-operative strategies currently used. The emphasis in this article is on general principles of treatment rather than treatment options for specific joints.

Tai Chi Mentions and Recommendations in Clinical Practice Guidelines: A Global Review

Introduction: Tai Chi is a moderate mindful physical activity with long historical practice. There are new and novel types and forms of Tai Chi with promising results. The aim of this narrative review was to assess the quantity of the presence of Tai Chi in clinical guidelines that recommended or mentioned Tai Chi globally. Materials and Methods: Three medical databases were searched from inception to November 1, 2021, the retrieved search results were screened by two authors according to inclusion and exclusion criteria. Literature in English language, which is a clinical guideline, and Tai Chi was mentioned or recommended in the text of the guideline were included. Results: A total of 1539 articles were retrieved after searching medical databases. Retrieved articles were screened by two authors for possible inclusion in this review. Finally, 50 clinical guidelines that mentioned Tai Chi were included. Tai Chi was recommended 38 times of the 50 included clinical guidelines that mentioned Tai Chi (76%). Tai Chi was mentioned mostly in clinical guidelines for pain management (n = 5), osteoarthritis (n = 5), and cancer (n = 5). Furthermore, Tai Chi was recommended in all included clinical guidelines for (pain management, low back pain, stroke, and Parkinson's disease). Conclusions: Tai Chi was recommended mostly in the management of pain and musculoskeletal diseases. Updating health promotion and chronic diseases management programs to include the new forms and types of mindful exercises according to the best scientific evidence is suggested. This review recommended performing future research and critical analysis assessing the quality of evidence of included clinical guidelines.

Osteoarthritis management care pathways are complex and inefficient: A qualitative study of physiotherapist perspectives from specialised osteoarthritis services.

Hip and knee osteoarthritis guidelines internationally provide consistent first-line care recommendations. However, uptake of these recommendations remains suboptimal. This qualitative study explores factors influencing guideline-based care from the perspectives of physiotherapists working in specialised osteoarthritis services across different models of care. Nineteen semi-structured interviews were conducted with physiotherapists working in specialist osteoarthritis services across three different Australian models of care (OsteoArthritis Hip and Knee Service n=10; OsteoArthritis Chronic Care Programme n=4; Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services n=5). Interviews were audio recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analysis. The overarching theme to emerge was that accessing first-line osteoarthritis care is complex and difficult, regardless of model of care. Subthemes indicated that: (i) services are either unavailable or inadequately funded, (ii) referral pathways are labyrinthine and lengthy, (iii) patients and other health professionals often believe that surgery is the only/best option and (iv) managing patient co-morbidities is challenging. Physiotherapists working in specialised osteoarthritis services perceive multiple and complex factors influencing adherence to first-line care. Barriers occur at various levels in all models of care, including patient and health professional beliefs, health service, and system levels. These results suggest improving healthcare for people with osteoarthritis requires urgent system reform.

Quality assessment of conventional and traditional oriental medicine clinical practice guidelines for knee osteoarthritis using AGREE II instrument.

Introduction:Knee osteoarthritis is a degenerative disease and its prevalence tends to increase. Clinical practice guidelines (CPGs) are evidence-based recommendations for treatment that help policymakers, practitioners, and patients make more appropriate and efficient decisions during the course of management. This study aimed to evaluate the quality of knee osteoarthritis CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.Method:The retrieval engines and websites were utilized from January 2010 to December 2020. The search words were “Clinical practice guideline” OR “Critical practice guideline” OR “guideline∗” AND “Osteoarthritis.” The quality of the CPGs was independently examined by four appraisers using the AGREE II instrument. Consequently, the selected CPGs were graded as Classes A, B, and C according to the level of recommendation.Result:In this study, 13 CPGs for knee osteoarthritis were selected and evaluated qualitatively using the AGREE II instrument. The overall quality percentage score was as follows: clarity of presentation, 72.6%, scope and purpose, 62.6%, rigor of development, 54.2%, stakeholder investment, 50.5%, editorial independence, 46.5%, applicability, 22.5%.Conclusion:Auxiliary materials for the treatment process of knee OA should be supplemented in future revised versions for quality improvement of knee OA CPGs. Also, more evidence should be accumulated to support the recommendation of traditional oriental medical treatments in the clinical field. From the perspective of integrative medicine, along with conventional pharmacological treatment, exercise, weight loss, and acupuncture can be combined together in clinical situations.

Physiotherapists\u2019 experiences of osteoarthritis guidelines in primary health care \u2013 an interview study

BackgroundOsteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists’ experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden.MethodsEighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis.ResultsThe analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management’s support and that guidelines should be easy to follow.ConclusionThe physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Implementation of the JIGSAW-E model for osteoarthritis. A role for Extended Scope Practitioners in primary care

Purpose: The Joint Implementation of Guidelines for Osteoarthritis (OA) in Western Europe (JIGSAW-E) model has been implemented across parts of Europe. It aims to optimise quality primary care, support self-management and promote the use of NICE guidelines. The aim of this project was to explore the feasibility of implementing the JIGSAW-E model in Scottish primary care.

Engagement between patients with obesity and osteoarthritis and primary care physicians: a cross-sectional survey

ABSTRACT Purpose of the Study Obesity is a major risk factor for development and worsening of osteoarthritis (OA). Managing obesity with effective weight loss strategies can improve patients’ OA symptoms, functionality, and quality of life. However, little is known about the clinical journey of patients with both OA and obesity. This study aimed to map the medical journey of patients with OA and obesity by characterizing the roles of health care providers, influential factors, and how treatment decisions are made. Study Design A cross-sectional study was completed with 304 patients diagnosed with OA and a body mass index (BMI) of ≥30 kg/m2 and 101 primary care physicians (PCPs) treating patients who have OA and obesity. Results Patients with OA and obesity self-manage their OA for an average of five years before seeking care from a healthcare provider, typically a PCP. Upon diagnosis, OA treatments were discussed; many (61%) patients reported also discussing weight/weight management. Despite most (74%) patients being at least somewhat interested in anti-obesity medication, few (13%) discussed this with their PCP. Few (12%) physicians think their patients are motivated to lose weight, but almost all (90%) patients have/are currently trying to lose weight. Another barrier to effective obesity management in patients with OA is the low utilization of clinical guidelines for OA and obesity management by PCPs. Conclusions As the care coordinator of patients with OA and obesity, PCPs have a key role in supporting their patients in the treatment journey; obesity management guidelines can be valuable resources. Plain Language Summary Osteoarthritis (OA) is a disease where the soft tissue between joints wears out causing pain and swelling. Obesity, having unhealthy extra body weight, increases the chances of a person getting OA and can make their OA worse. We wanted to learn more about what patients with OA and obesity experience as they try to manage their OA, including the doctors they talked to, the treatments they used, and if their weight was discussed. To better understand this journey, 304 people with OA and obesity and 101 primary care doctors who treat people with OA and obesity took an online survey. We found that people with OA and obesity tried to manage their OA symptoms on their own for an average of five years before going to a doctor for help. Many (54%) talked with their primary care doctor first. When people with obesity were told by doctors that they had OA, most people (61%) said that they talked about weight and weight loss. Most people (72%) also talked with their doctors about OA treatments. Few doctors (12%) thought their patients were serious about losing weight but almost all patients (90%) said they had tried or were still trying to lose weight. About half of doctors followed guidelines for taking care of people with OA (51%) and obesity (61%). Primary care doctors play a key role in helping patients with OA and obesity. Doctors can follow guidelines and provide treatment options including referrals to other specialists to support weight loss efforts.

Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

Background and purpose — Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and—if necessary—weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008–2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008–2012) compared with after (2012–2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods — Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results — Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2–5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs –8.6% (CI –9.6 to –7.6), weak opioids –6.8% (CI –7.7 to –5.9), glucosamine –9.5% (CI –9.8 to –8.8). and hyaluronic acid –1.6% (CI –1.8 to –1.5) but discordantly increased for strong opioids 2.8% (CI 2.1–3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0–3.1). Interpretation — In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes non-pharmacological before pharmacological interventions. Additional modest improvements occurred in the stepped-care prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.

Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol

Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a ‘model of evidence-based, non-surgical OA care that has been implemented in a real-world setting’. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE‐CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.

Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol.

Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a 'model of evidence-based, non-surgical OA care that has been implemented in a real-world setting'. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE-CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.

Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation: A Review.

Early, frequent rehabilitation is an important factor for optimizing stroke recovery outcomes. Medical comorbidities, such as osteoarthritis, that affect the ability to participate in rehabilitation could therefore have a detrimental impact on such outcomes. Both stroke and osteoarthritis are becoming more common in developed nations as the population ages. First-line osteoarthritis treatments, such as oral nonsteroidal anti-inflammatory drugs, are often avoided poststroke due to interaction with secondary prevention stroke risk-factor management. Our objective was to summarize the current literature concerning co-occurring osteoarthritis and stroke prevalence, its functional impact, and treatment options. Narrative review using a comprehensive literature search of PubMed, osteoarthritis, and stroke guidelines. Outcomes related to co-occurrence prevalence, osteoarthritis as a stroke risk-factor, osteoarthritis-related imaging and treatment were extracted and summarized descriptively. Overall quality of the evidence was summarized using Grading of Recommendations Assessment, Development and Evaluation. We identified 23 studies and guidelines related to our objective. Overall quality of the evidence was very low. Few trials have investigated the relationship between osteoarthritis and stroke, nor osteoarthritis-specific pain and function management for stroke survivors. High-quality research evaluating the impact of osteoarthritis on stroke rehabilitation is needed.

Arthroscopy Association of Canada Position Statement on Exercise for Knee Osteoarthritis: A Systematic Review of Guidelines.

Background:Exercise is widely regarded to improve pain and function in patients with knee osteoarthritis (OA) through building supportive muscle mass, facilitating weight loss, and through the other beneficial effects associated with it.Purpose:To explore literature that presents clinical guidelines for the use of exercise in the treatment of knee OA to inform an evidence-based position statement for the Arthroscopy Association of Canada.Study Design:Position statement.Methods:PubMed, MEDLINE, Embase, and Cochrane databases were searched for guidelines commenting on the role of exercise for knee OA. The search was limited to guidelines published in the last 10 years. Articles were screened for relevance, focusing on recently published research with clinical guidelines. Inclusion criteria involved all articles providing clinical guidelines for exercise and knee OA.Results:Eight guidelines were identified. All eight recommended exercise as an important component of treatment for knee OA, with 6/8 strongly recommending it.Conclusion:Exercise is an effective and important component of the non-pharmacological management of knee OA. The Arthroscopy Association of Canada strongly recommends the use of exercise in the management of knee OA.

Comorbidities, imaging and treatment – a validation study of self-reported information and administrative data from 38,745 patients with knee and hip osteoarthritis

Purpose: Good Life with osteoArthritis in Denmark (GLA:D®) is a nationwide program which aims to implement treatment guidelines for knee and hip OA in clinical practice collecting self-reported information. The purpose of this study was to examine the agreement between self-reported information obtained from patients with knee and hip osteoarthritis (OA) in primary care against administrative data from high quality nationwide Danish registries.

Footwear for self-managing knee osteoarthritis symptoms: the footstep randomized controlled trial

Purpose: Self-management strategies, exercise and weight control, are core treatment recommendations for people with knee osteoarthritis (OA). Biomechanical interventions such as “appropriate” footwear are included as a key self-management strategy in international OA guidelines due to the important role excessive knee joint loading plays in knee OA onset and progression. However, there is limited evidence to guide clinicians and patients on which footwear is best for knee OA. International guidelines advise shoes with shock absorbing properties and arch support features for knee OA patients.

Patient Forgoes Knee Replacement Surgery by at Least 2 Years After Appropriate Nonsurgical Care Following Cardiac Rehabilitation: A Case Report

Background Guidelines for knee osteoarthritis recommend that appropriate nonsurgical care, including education and exercise therapy, be offered prior to considering total knee replacement (TKR) surgery. Case Description A 66-year-old man with severe knee osteoarthritis was scheduled for TKR. Preoperative cardiac testing led to cardiac surgery and subsequent appropriate nonsurgical care for his knee osteoarthritis. This included aerobic exercise (cardiac rehabilitation) and a targeted exercise therapy and education program (Good Life with osteoArthritis in Denmark [GLA:D]®). Outcome and Follow-Up Following the 6-week cardiac rehabilitation program, the patient's walking distance improved by 130 m (39% improvement during the 6-minute walk test). Following the 6-week GLA:D® program, average knee pain reduced by 76% (6.5-cm reduction on a 10-cm visual analog scale) and joint-related quality of life improved by 72% (50 units using the Knee injury and Osteoarthritis Outcome Score [KOOS]). At 2-year follow-up, this patient had still not undergone a TKR. Discussion This case avoided a TKR for at least 2 years after accidentally receiving appropriate nonsurgical care. JOSPT Cases 2021;1(1):21–26. doi:10.2519/josptcases.2021.9943