EULAR: Providers should counsel patients with hip, knee osteoarthritis on self-management
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Key takeaways:
- The top recommendation was that patients should be offered information on self-management strategies that are reinforced at later clinic visits.
- Questions for future research were also proposed.
Patients with hip or knee osteoarthritis should receive education and counsel on self-management strategies across repeat clinical visits, according to updated recommendations from EULAR.
“Hip and knee osteoarthritis are increasingly common, with a significant impact on individuals and society,” Tuva Moseng, PhD, of Diakonhjemmet Hospital, in Oslo, Norway, and colleagues wrote in the Annuals of the Rheumatic Diseases. “Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life.”
Updates to EULAR’s 2013 recommendations on non-pharmacological core management of hip and knee OA were needed “given the large number of subsequent studies,” they added.
To draft the updated recommendations, Moseng and colleagues formed a 25-member multidisciplinary task force, including nine physiotherapists, six rheumatologists, two orthopedic surgeons and two psychologists. Members conducted a systemic review of literature from Jan. 1, 2012, through May 27, 2022.
The task force searched the literature for systematic reviews and meta-analyses of randomized controlled trials, as well as evidence from single, randomized controlled trials, and performed their own systematic review of culled RCTs. Results of the review were discussed among the task force, which subsequently voted on revisions to the overarching principles and recommendations.
As a result, two former recommendations were adapted into overarching principles:
- In patients with hip or knee OA, initial assessment should use a biopsychosocial approach to consider physical and psychological status, activities of daily living, participation including work, social determinants and environmental factors.
- Treatment of people with hip or knee OA should be based on shared decision-making considering the needs, preferences and capabilities of the individual.
According to the task force, the recommendation with the highest priority for implementation was that patients with hip or knee OA “should be offered information, education and advice on self-management strategies,” that are “reinforced at subsequent clinical encounters.” This recommendation could help enable physical activity and assist patients to “live a good life with OA,” Moseng and colleagues wrote.
The task force also combined two previous recommendations on footwear, walking aids and assistive devices into one. The recommendation now simply states that providers should consider “walking aids, appropriate footwear, assistive devices and adaptations at home and at work” to manage pain and increase participation in patients with hip or knee OA.
Other points in the updated recommendations include:
- Providers should offer an “individualized, multicomponent management plan” that features recommended core non-pharmacological approaches.
- All patients with hip or knee OA should be offered exercise strategies, such as strength, aerobic, flexibility or neuromotor techniques, “of adequate dosage with progression” based on their individual physical function, preferences and available services.
- Exercise delivery — whether in individual or group sessions, supervised or unsupervised, face-to-face or remote, land or aquatic — should be based on local availability and patient preferences.
- Providers should offer education on the importance of maintaining a healthy weight, with support for those with overweight or obesity.
- Patients at risk for work disability should receive advice on modifiable work-related factors and, when appropriate, referral for expert advice.
- Providers should consider using elements of behavior change techniques when lifestyle modifications are needed, such as physical activity or weight loss.
The task force additionally proposed avenues for future research, based on gaps in the current literature, such as determining how to prescribe optimal exercise dosage in hip or knee OA, how go improve long-term adherence to non-pharmacological treatment, and how uptake of core management strategies can be improved.
“As the OA population is growing, the need for effective health care utilization and sustainable management strategies to improve outcomes will be vital to minimizing the burden of OA at an individual and a societal level,” Moseng and colleagues wrote. “The [task force] reached broad consensus on the updated recommendation for non-pharmacological core OA management, as well as on a research agenda highlighting the current evidence gaps, on an educational agenda and on the priority of the recommendations to support implementation activities.”
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