EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis

Objective. To establish priority key messages for patients with osteoarthritis (OA). Methods. A Delphi survey and priority pairwise ranking activity was conducted. Participants included 51 OA experts from 13 countries and 9 patients (consumers) living with hip and/or knee OA. During 3 Delphi rounds, the panel of experts and consumers rated recommendations extracted from clinical guidelines and provided additional statements they considered important. When ‡70% of panel members agreed a statement was "essential," it was retained for the next Delphi round. The final list of essential statements was reviewed by a consumer focus group and statements were modified for clarity if required. Finally, a priority pairwise ranking activity determined the rank order of the list of essential messages. Results. Eighty-five experts and 15 consumers were invited to participate; 51 experts and 9 consumers completed round 1 of the Delphi survey, and 43 experts and 8 consumers completed the final priority ranking activity. From an original list of 114 statements, 21 statements were rated as essential. Most statements (n 5 17) related to nondrug treatment approaches for OA. Study limitations included that >50% of the panel comprised of physical therapists lead to high rankings of exercise and physical activity statements and also that only English-language statements were considered. Conclusion. OA experts and consumers have identified and prioritized 21 key patient messages about OA. These messages may be used to inform the content of consumer educational materials to ensure patients are educated about the most important aspects of OA and its management.

Section: Methodsmentioning

confidence: 99%

What Do People With Knee or Hip Osteoarthritis Need to Know? An International Consensus List of Essential Statements for Osteoarthritis

French

Bennell

Nicolson

et al. 2015

“…Exercise therapy is a key intervention in the management of knee osteoarthritis (OA) and recommended in international guidelines on knee OA management (1,2). It is an effective intervention to improve physical functioning and to reduce joint pain in patients with knee OA (3).…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines on knee OA do not provide guidance on tailoring exercise therapy to the presence of comorbidity (1,2,15,16). In clinical practice, comorbidity is a frequent reason to exclude patients from exercise therapy (17).…”

Section: Introductionmentioning

confidence: 99%

“…Exercise therapy comprised a 20-week individualized (tailored) knee OA exercise program, with 2 sessions of 30-60 minutes per week under the supervision of a PT. The exercise therapy provided in the present study was based on the protocol developed by Knoop et al (12) and consisted of muscle-strength training of the lower extremity, aerobic training, and training of daily activities (1,2,12,16 1002/acr.23013/abstract). In the diagnostic phase, comorbidityrelated contraindications and restrictions were identified by history taking and physical examination in an extensive 1-hour intake procedure.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

MSc

Leeden

Cheung

et al. 2017

100

Objective. To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods. In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ‡30 kg/m 2 ), with severity score ‡2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities. The control group received their current medical care for knee OA and were placed on a waiting list for exercise therapy. Primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, subscale physical functioning (WOMAC-pf), and the 6-minute walk test (6MWT). Measurements were performed at baseline, after 20 weeks (directly posttreatment), and at 3 months posttreatment. Results. Statistically significant physical functioning differences over time were found between the intervention and control group (WOMAC: B 5 27.43 [95% confidence interval (95% CI) 29.99, 24.87], P < 0.001; and 6MWT: B 5 34.16 [95% CI 17.68, 50.64], P < 0.001) in favor of the intervention group. At 3 months followup, the mean improvements in the intervention group were 33% on the WOMAC scale and 15% on the 6MWT. These improvements are of clinical relevance. No serious adverse events occurred during the intervention. Conclusion. This is the first study showing that tailored exercise therapy is efficacious in improving physical functioning and safe in patients with knee OA and severe comorbidities.

“…However, recommendations remain inconsistent. Internationally, some guidelines issue a conditional recommendation (16,17), while others do not recommend use of lateral wedge insoles on the basis of equivocal evidence of any benefit on pain or knee function (18). A recent meta-analysis demonstrated an effect of lateral wedge insoles on pain outcomes below the minimally clinical important difference for OA (19).…”

Section: Introductionmentioning

confidence: 99%

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Arnold

Wong

Jones

et al. 2016

Objective. Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods. Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects metaanalysis.Results. Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] 20.19; 95% confidence interval [95% CI] 20.23, 20.15) and second peak EKAM (SMD 20.25; 95% CI 20.32, 20.19) with a low level of heterogeneity (I 2 5 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD 20.14; 95% CI 20.21, 20.07, I 2 5 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion. Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.