Osteoarthritis: Conservative therapy delays need for knee and hip joint replacement surgery

August 19, 2020

"It is wise to consider all non-surgical treatment options before resorting to an artificial hip or knee joint implant," said EULAR President Professor Iain B. McInnes, University of Glasgow, Scotland. Yet in many cases, doctors and patients fail to exhaust the full range of conservative therapy options. A Norwegian study has now shown how many patients with osteoarthritis (OA) can benefit from a qualified, conservative therapy programme.

The study design, a so-called cluster-randomised trial (CRT), comprised a programme developed based on international treatment recommendations for hip and knee osteoarthritis (OA). It included an initial three-hour patient education programme, among other things. This was followed by 8-12 weeks of individually tailored exercises supervised by physiotherapists. The programme was facilitated by general practitioners, primary care physicians and physiotherapists, who also received prior training. A total of 393 patients participated in the study; 284 were included in the special osteoarthritis programme and 109 (control group) continued their usual care. The participants were at least 45 years old and presented with clinical OA symptoms such as reduced mobility or pain. They were re-examined 12 months after the beginning of the programme. The study parameters included but were not limited to quality of care, satisfaction with care, physical activity, and referrals to physiotherapy or orthopaedic surgeons. The researchers also recorded whether joint replacement surgery was performed.

92 percent of the patients participated in the patient education programme and 64 percent completed a minimum participation period of at least eight weeks of exercise. Twelve months later, the intervention group reported a significantly higher quality of care (score of 58, versus 41 for the control group). The study participants also reported significantly higher satisfaction with care (Odds ratio (OR) 7.8; 95% CI 3.55, 17.27). A significantly larger proportion (OR: 4.0; 95% CI 1.27, 12.63) also met the recommendations for physical activity compared to the control group. A smaller proportion was referred to orthopaedic surgeons (OR 0.5; 95% CI 0.29, 1.00) and an even smaller proportion (4%) received joint replacement surgery during the observation period, compared to the control group (11%, OR 0.3; 95% CI 0.14, 0.74).

"The implementation of a structured model for OA care led to an improved quality of care, higher patient satisfaction and increased physical activity, despite OA," stated co-author of the study Tuva Moseng, Diakonhjemmet Hospital, Oslo, Norway. There is also some evidence to suggest that a structured OA programme including patient education and exercise may delay or even reduce the need for surgery after 12 months.

Professor John Isaacs from Newcastle University, UK, and Chair of the EULAR 2020 Scientific Programme Committee summarised: "Once again, we see just how important and effective consistent, conservative therapy is for our OA patients." He urged that "conservative care based on the international recommendations for OA treatment should become the standard for all patients."

Nina Osteras, Tuva Moseng et al.: Higher quality of care and less surgery after implementing osteoarthritis guidelines in primary care- long-term results from a cluster randomized controlled trial, DOI: 10.1136/annrheumdis-2020-eular.3575 3575

Event information:

EULAR 2020. Online access to scientific contributions will be available until 1 September 2020. Please register here: https://www.congress.eular.org/press_registration_form_2020.cfm

German Society for Rheumatology (DGRh) E-Congress, 9-12 September

EULAR 2021, 02 - 05 June 2021, Paris, France

European League Against Rheumatism

Related Physical Activity Articles from Brightsurf:

Physical activity in the morning could be most beneficial against cancer
The time of day when we exercise could affect the risk of cancer due to circadian disruption, according to a new study with about 3,000 Spanish people  

Physical activity and sleep in adults with arthritis
A new study published in Arthritis Care & Research has examined patterns of 24-hour physical activity and sleep among patients with rheumatoid arthritis, lupus, and knee osteoarthritis.

Regular physical activity seems to enhance cognition in children who need it most
Researchers at the Universities of Tsukuba and Kobe re-analyzed data from three experiments that tested whether physical activity interventions lead to improved cognitive skills in children.

The benefits of physical activity for older adults
New findings published in the Scandinavian Journal of Medicine & Science in Sports reveal how physically active older adults benefit from reduced risks of early death, breast and prostate cancer, fractures, recurrent falls, functional limitations, cognitive decline, dementia, Alzheimer's disease, and depression.

Physical activity may protect against new episodes of depression
Increased levels of physical activity can significantly reduce the odds of depression, even among people who are genetically predisposed to the condition.

Is physical activity always good for the heart?
Physical activity is thought to be our greatest ally in the fight against cardiovascular disease.

Physical activity in lessons improves students' attainment
Students who take part in physical exercises like star jumps or running on the spot during school lessons do better in tests than peers who stick to sedentary learning, according to a UCL-led study.

Physical activity may attenuate menopause-associated atherogenic changes
Leisure-time physical activity is associated with a healthier blood lipid profile in menopausal women, but it doesn't seem to entirely offset the unfavorable lipid profile changes associated with the menopausal transition.

Are US adults meeting physical activity guidelines?
The proportion of US adults adhering to the 'Physical Activity Guidelines for Americans' from the US Department of Health and Human Services didn't significantly improve between 2007 and 2016 but time spent sitting increased.

Children from disadvantaged backgrounds do less vigorous physical activity
Children from disadvantaged backgrounds and certain ethnic minority backgrounds, including from Pakistani and Bangladeshi backgrounds, have lower levels of vigorous physical activity, according to researchers at the University of Cambridge.

Read More: Physical Activity News and Physical Activity Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.