Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis

Abstract

In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched (ie, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE PreMEDLINE, PubMed, and the Agency for Healthcare Research and Quality website) and evaluated the literature, created a simple 1-page algorithm, and advanced 19 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. This synopsis summarizes key recommendations in all 6 topics covered in the guideline. These topics are diagnosis, self-management, physical therapy, pharmacotherapy, orthobiologics, and complementary and integrative health.

The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial

“…The effect of proprioceptive training on pain intensity was not maintained over time in our study or in previous studies that performed similar conservative interventions of orthotic intervention, exercise, or ADL re-education [ 41 , 42 , 43 ]. Based on other research, proprioceptive work may help to recover the osteoarticular balance and coordination and improve the performance of daily activities and consequently decrease pain intensity [ 44 , 45 , 46 ].…”

Caring for adults with hip pain

“…Dietary counseling and weight reduction for patients with a BMI greater than 25 can significantly decrease hip pain. 3,16,[21][22][23] New guidelines from the National Institute for Health and Care Excellence 16 recommend an exercise program and physical activity as a priority over medication administration for chronic pain. Self-management to decrease pain may include activities such as aquatic exercises, stretching, weight training, and aerobics.…”

“…Self-management to decrease pain may include activities such as aquatic exercises, stretching, weight training, and aerobics. 3,[21][22][23] Exercise may help strengthen muscles early in the disease pro-cess or as a part of rehabilitation post-surgery. Patients may perform abduction and external rotation resistance exercises to strengthen the hip muscles.…”

“…24 Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, serotonin, and norepinephrine reuptake inhibitors are often prescribed to decrease pain. 22 The nurse should be aware of liver and renal function when administering acetaminophen. In addition to hepatotoxicity, chronic acetaminophen use may be associated with chronic kidney disease, hypertension, chronic daily headache, and peptic ulcer disease.…”

Intra-articular drug delivery systems for osteoarthritis therapy: shifting from sustained release to enhancing penetration into cartilage

“…Further, the cause of OA is still unclear. It is not caused by a single factor but a result of the combination of multiple factors, among which old age and overweight are the main pathogenic factors (Krishnamurthy et al., 2021 ). The work capacity of OA patients is greatly impaired, which affects their quality of life and causes an economic burden on individuals and society (Losina et al., 2015 ).…”