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. 2023 Sep 28;5(4):100411.
doi: 10.1016/j.ocarto.2023.100411. eCollection 2023 Dec.

Usage of guideline-adherent core treatments for knee osteoarthritis before and after consulting an orthopaedic surgeon: A prospective cohort study

Simon Majormoen Bruhn  1 , Søren T Skou  2   3 , Lasse Kindler Harris  1 , Thomas Bandholm  4   5   6   7 , Anne Møller  8 , Henrik M Schrøder  9   10 , Anders Troelsen  1 , Lina Holm Ingelsrud  1
Affiliations

Usage of guideline-adherent core treatments for knee osteoarthritis before and after consulting an orthopaedic surgeon: A prospective cohort study

Simon Majormoen Bruhn et al. Osteoarthr Cartil Open. .

Abstract

Objective: To describe 1) the proportion of patients with knee osteoarthritis (OA) undergoing guideline-adherent core treatments until six months after primary referral to an orthopaedic surgeon, 2) which specific treatment pathways these patients undertake and 3) the characteristics of patients choosing different treatment pathways.

Design: This prospective cohort study consecutively invited patients referred to an orthopaedic surgeon due to knee OA at two Danish hospitals from October 2018 to December 2020. Before and six months after consulting the surgeon, patients answered a questionnaire reporting which treatments they had received for knee OA. The proportion receiving the combination of guideline-adherent treatments (i.e., exercise, education, and dietary weight management if needed) was determined. We evaluated the specific treatment usage before and until six months after the consultation and investigated characteristics of patients undertaking different pathways.

Results: Out of 5251 eligible patients, 2574 (49%) had complete data and were included in analyses. 23% received guideline-adherent treatments, 10% had no treatment. Patients underwent 1143 unique treatment pathways, 62% including treatments not recommended/recommended against. Those who underwent guideline-adherent pathways had similar characteristics to those who did not but tended to be females, retired, had longer-lasting knee problems, have comorbidities, and higher education levels.

Conclusions: Only one in four patients with knee OA received treatment adhering to clinical guidelines before and six months after consulting the surgeon. Patients used many different treatment pathways. There is a need for a structured effort to increase the use of guideline-adherent core treatments.

Trial identifiers: Registration: NCT03746184, Protocol: PMID: 34233992.

Keywords: Clinical guidelines; Core treatments; Exercise; Knee arthroplasty; Knee osteoarthritis; Patient education.

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Conflict of interest statement

STS is associate editor of JOSPT, has received personal fees from Munksgaard, TrustMe-Ed and Nestlé Health Science, outside the submitted work, and is co-founder of GLA:D®, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice.

Figures

Fig. 1
Fig. 1
Flowchart for patient inclusion and exclusion, non-respondents, reasons for exclusion and dropout and the number of respondents included in the analyses. Non-respondents were either patients who did not wish to participate in the study or were deceased in the follow-up time. In addition, non-respondents were patients who did not respond to our requests to answer the questionnaires and whom we could not contact in the outpatient clinics. Numbers in parentheses show the response rate for respondents at inclusion and at six-month follow-up, respectively.
Fig. 2
Fig. 2
Number of patients receiving the guideline-adherent core treatments and combinations until six months after the consultation. Combinations of core treatments are illustrated as one or more circles overlapping another. Percentages represent the proportions out of all 2574 included patients. The number of patients reporting to have received dietary weight management is displayed for all, disregarding their BMI. It should be noticed that dietary weight management was only relevant for 2110 patients with BMI ≥ 25 and for 1084 patients with BMI ≥ 30 (Table 3).
Fig. 3
Fig. 3
The number of treatment pathways comprising one or more core treatments.
See this image and copyright information in PMC

References

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