Experience of living with knee osteoarthritis: a systematic review of qualitative studies

Wallis, Jason; Taylor, Nicholas F.; Bunzli, Samantha; Shields, Nora

doi:10.1136/bmjopen-2019-030060

Cited by 97 publications

(82 citation statements)

References 62 publications

(215 reference statements)

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“…In the present study, very few AEPs advised on exercise and pain (10%), with 68% limiting exercise prescription to nonpainful exercise. The AEPs who did ‘explain pain’ during exercise reassured patients that discomfort or tolerable/manageable pain is normal and safe, which is consistent with current thinking (Booth et al, 2017; Smith et al, 2018; Wallis, Taylor, Bunzli, & Shields, 2019). Providing patients with clear advice on exercise and pain is important, as conflicting information can leave patients unaware of whether or not exercising with pain is safe and hinder engagement (Booth et al, 2017; Smith et al, 2017).…”

Section: Discussionsupporting

confidence: 70%

Exercise and education for knee osteoarthritis—What are accredited exercise physiologists providing?

Ram

Booth

Thom

et al. 2020

Musculoskeletal Care

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Objectives: Clinical guidelines for the non-surgical management of knee osteoarthritis (OA) recommend exercise and education. This study aimed to evaluate the extent to which accredited exercise physiologists (AEPs) deliver exercise and education for knee OA and how it aligns with clinical practice guidelines. Design: Cross-sectional survey. Method: An online survey targeted to AEPs across Australia to understand the exercise and education content of their interventions for knee OA. Likert scale and multiple-choice questions were used to measure responses relating to exercise prescription. Thematic analysis was used to evaluate the nature of education being delivered by AEPs. The revised neurophysiology of pain questionnaire (r-NPQ) was used to quantify pain neuroscience knowledge. Results: A total of 161 AEPs completed the survey (63 men, 98 women; mean experience 5.8 ± 4.7 years). Exercises commonly prescribed included: strength (99% of respondents), weight bearing (90%) and aerobic (83%), with 98% of AEPs prescribing exercise for the affected and unaffected limb. Only 32% of respondents frequently considered prescribing 'exercise into pain'. The four main education themes were exercise (86%), self-management (61%), weight loss (56%) and pain management (51%). Specific pain neuroscience education (PNE) was provided by only 21% of respondents. Conclusions: Exercise prescription mostly aligned with evidence-based recommendations. The education component of AEP interventions for knee OA focused on the benefits of exercise. However, other education guideline recommendations about the disease, appropriate treatments and self-management were underutilised. The PNE knowledge of AEPs was comparable with other secondary care providers, although only a minority of AEPs provide PNE.

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Section: Discussionsupporting

confidence: 70%

Exercise and education for knee osteoarthritis—What are accredited exercise physiologists providing?

Ram

Booth

Thom

et al. 2020

Musculoskeletal Care

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“…Persistent pain and limited functional capacity results in low quality of life and mental wellbeing (Araujo et al, 2016), and the loss of independence and lack of participation in meaningful activities had an emotional and social impact on the lives of the participants in this study. Similar findings in a systematic review by Wallis et al, (2019) showed that people living with knee OA has limited ability to stay socially connected due to reduced mobility which impacted their participation in social and leisure activities and lead to emotional distress such as anxiety and loss of self-worth.…”

Section: Discussionsupporting

confidence: 72%

Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa: an exploratory qualitative study

Coetzee

Giljam-Enright

Morris

2020

Prim Health Care Res Dev

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Background: Current clinical practice guidelines have suggested that each individual with knee osteoarthritis (OA) should receive three core treatments from their health care provider. These core treatments comprise of exercise, education and weight loss. Identification of the health care and rehabilitation needs of individuals with knee OA in rural areas are imperative for focusing service delivery in a specific context in order to empower the individual. The aim of this study was to explore the rehabilitation needs of individuals with knee OA living in rural Western Cape in order to identify the gaps in services offered and inform rehabilitation programmes in these settings. Methods: Semi-structured in-depth individual interviews were performed on 16 individuals with knee OA living in rural settings of the Western Cape, South Africa. A deductive data analysis approach was used and the needs of the individuals were identified and categorised for interpretation and comparison with the reported services received. Findings: The three major themes identified were ‘I would like to know more’, ‘There’s not much support from the clinic’ and ‘I don’t feel myself anymore’. These themes relate to the lack of disease-specific education, barriers in the health systems and service delivery resulting in individuals lack of self-worth and poor mental wellbeing. The results revealed the integral relationship between health care systems, service delivery and the effect on patient wellbeing. Conclusion: The rehabilitation needs of individuals with knee OA in rural areas advocates for addressing barriers in rural primary health care system such as adequate human resources, referral systems and continuity of care. This will allow for a comprehensive, person-centred and context-specific multidisciplinary approach focused on empowering individuals with knee OA through disease-specific education, improving functional participation and symptom management strategies. This could improve the social inclusion and mental wellbeing of individuals living with knee OA.

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“…OA that does not appear to be driven by major modifiable risk factors, such as weight, and occurs in older patients is often described as "degenerative" OA. It has been documented that some providers consider OA of this nature in older adults who are non-overweight as a "wear-and-tear" phenomenon not amenable to treatment (43)(44)(45) ; yet, it is prevalent and can still result in poor patient outcomes: 15.2% of participants in the OAI showed evidence of osteoporosis, (46) subchondral bone abnormalities have been shown to be better correlated with future knee pain than with cartilage thinning, (46) and many patients with this "degenerative OA" go on to receive total knee replacement procedures. (9) If prevention of this type of OA by early, potent bisphosphonate therapy is possible, especially in those with evidence of at least moderate fracture risk with concurrent early OA or risk factors for OA, perhaps prevention of degenerative OA is possible as well.…”

Section: Journal Of Bone and Mineral Researchmentioning

confidence: 99%

Bisphosphonate Use Is Protective of Radiographic Knee Osteoarthritis Progression Among those With Low Disease Severity and Being Non-Overweight: Data From the Osteoarthritis Initiative

Hayes

Giannakeas

Wong

2020

Journal of Bone and Mineral Research

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Antiresorptive medications have been explored for treating knee osteoarthritis (OA); however, little data exist on the effects of today's more potent nitrogen‐containing oral bisphosphonates on radiographic disease‐progression in patients with varying disease‐severity, especially those who are not overweight. The primary objective of this cohort study was to determine if the use of bisphosphonates is protective against 2‐year radiographic‐progression of knee OA in Osteoarthritis Initiative (OAI) participants, stratified by baseline radiographic disease status. Secondary objectives were to examine effects in non‐overweight participants (body mass index [BMI] < 25 kg/m2) and cumulative bisphosphonate exposure effects. We identified female OAI participants aged ≥50 years and excluded those missing baseline radiograph readings, bisphosphonate use information, or all clinical questionnaire information at baseline. Participants reporting bisphosphonate use (69% alendronate) were propensity‐matched 1:1 to non–bisphosphonate users and followed until first radiographic knee OA progression (1‐unit increase in Kellgren and Lawrence [KL] grade) or data were censored (first missed visit or end of 2‐year follow‐up). Discrete‐time logistic regression models estimated hazard ratios (HRs) between bisphosphonate users versus nonusers, with an interaction term for baseline KL grade (KL <2 or KL ≥2). We identified 1977 eligible women (n = 346 bisphosphonate users). Propensity‐matched results indicated that bisphosphonate users with KL grade <2 were protected against progression (HRKL<2 0.53; 95% CI, 0.35 to 0.79), while bisphosphonate use was not associated with radiographic progression in those with KL grade ≥2 (HRKL≥2 1.06; 95% CI, 0.83 to 1.35). When restricting analyses to those with BMI <25 kg/m2, effects were strengthened (HRKL<2 0.49 [95% CI, 0.26 to 0.92]; HRKL≥2 0.69 [95% CI, 0.33 to 1.26]). Duration of bisphosphonate use had no effect on progression, though sample size was limited. Bisphosphonate therapy may be protective against radiographic knee OA progression in early‐stage patients, particularly those who are non‐overweight, but less so for those with more advanced disease or more weight‐bearing joint stress. © 2020 American Society for Bone and Mineral Research (ASBMR).

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Experience of living with knee osteoarthritis: a systematic review of qualitative studies

Cited by 97 publications

References 62 publications

Exercise and education for knee osteoarthritis—What are accredited exercise physiologists providing?

Exercise and education for knee osteoarthritis—What are accredited exercise physiologists providing?

Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa: an exploratory qualitative study

Bisphosphonate Use Is Protective of Radiographic Knee Osteoarthritis Progression Among those With Low Disease Severity and Being Non-Overweight: Data From the Osteoarthritis Initiative

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