Physical Activity Intervention in Primary Care and Rheumatology for the Management of Knee Osteoarthritis: A Review

Abstract

Physical activity (PA) is recommended by osteoarthritis (OA) international organizations as an essential component of first-line management of knee OA. Primary care physicians (PCP) and rheumatologists can play a key role in promoting PA but the extent that PA recommendation is occurring in primary and rheumatology care is unclear. This review provides an overview of current practice of PCP- and rheumatology-delivered PA intervention in the United States, Canada and Europe for the management of knee OA and explores barriers to implementing PA intervention in primary and rheumatology care. A search of MEDLINE from 2000-April 2017 was conducted, 848 abstracts were identified from which 22 relevant articles were selected for this review. Overall, recommendation of PA is suboptimal - the majority of studies reported that < 50% of PCPs and rheumatologists make this recommendation to people with knee OA. Key barriers identified were time constraints, lack of patient motivation, PA-specific resources and financial reimbursement, concerns about inadequate training and knowledge for detailed exercise prescription and beliefs about the efficacy of exercise in the management of OA and their role in providing PA intervention. There is a sparsity of data about rheumatology practice and barriers to PA intervention among this group. In summary, this review suggests that there is a notable gap between what clinical guidelines recommend and what is happening in clinical practice. Addressing this practice gap through addressing key barriers provides an opportunity for improving OA care and ultimately, the health and quality of life of people with OA. This article is protected by copyright. All rights reserved.

Recommendation Rates for Physical Therapy, Lifestyle Counseling, and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings: A Cross‐Sectional Analysis of the National Ambulatory Care Survey (2007–2015)

“…The decrease in PT and lifestyle counseling is surprising because promoting physical activity interventions is a front-line approach for knee OA according to most clinical practice guidelines (4,6,7,15,16). The results of our study align with previous reports on OA that suggested an increase in trends of opioid prescriptions (17,18) and a low rate of lifestyle or PT interventions in clinical settings (19,20). The current evidence underscores the need for further investigation to explain why adherence to evidence-based practices is suboptimal and to investigate methods to effectively promote guideline-based care.…”

Physical Activity Assessment and Recommendation for Adults With Arthritis by Primary Care Providers—DocStyles, 2018

“…For example, in a 2019 review, the majority of studies found that approximately half or fewer providers counseled (defined in the review as advised, recommended, or prescribed) on physical activity for their patients with knee osteoarthritis. 20 In addition, a 2011 study found that 93% of rheumatology providers (rheumatologists, rheumatology nurses, and physical therapists) from the Netherlands reported always/regularly recommending/advising physical activity for their patients with rheumatoid arthritis. 32 While this study is not methodologically identical to the current study and the latter may not be generalizable to health care providers in the US, findings of these 2 studies are reasonably comparable to those of the current study, which found that 57.7% of PCPs always and 98.4% always or sometimes recommend physical activity to their patients with arthritis.…”

“…19 Studies of providers show similar results. In a 2019 review, the majority of studies found that less than half of primary care providers (PCPs) and rheumatologists recommended physical activity to their patients with osteoarthritis, and less than half of patients received a recommendation 20 ; the majority of studies in this review were from outside of the US and reported on differences by patient, rather than provider, characteristics. To address these knowledge gaps, this study examined 2 components of physical activity counseling: assessment and recommendation.…”

‘Function First—Be Active, Stay Independent’—promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design

“…Previous reviews have explored the effects of physical activity interventions in sedentary adults and those with long-term conditions in the primary care setting 25–28. Barriers and facilitators to physical activity and the effectiveness of different modes of delivery have been explored 29–32.…”