OA knee: physio & exercise less prescribed over painkiller|study

Last updated on June 12th, 2020 at 11:17 am

The potential of physical therapy, exercises, and lifestyle modification is underutilized in knee osteoarthritis sufferer and to the contrary, there’s increased use of pain medication, reveals a recent study.

A recent US study published in Arthritis Care & Research centers published on 8th September 2019 reveals that patients with Knee Osteoarthritis, Physiotherapy and lifestyle counseling seem underutilized while pain medication use increased during the investigated timeframe.

“Despite being part of clinical practice guidelines, exercise-based interventions are still being prescribed at a very low rate. More research is needed to determine barriers to prescribing exercise,” explained lead author Samannaaz Khoja, PT, Ph.D., Research Assistant Professor at the University of Pittsburgh School of Health and Rehabilitation Sciences’ Department of Physical Therapy.

Let’s try to understand what this research is all about, during which timeframe this study was conducted and what made researchers conclude this.

Research methodology

For the recent study, experts examined data from the National Ambulatory Medical Care Survey (NAMCS) database from the year 2007 to 2015.

The NAMCS conducts a survey on a yearly basis during which physicians are randomly assigned a 1-week data collection period. The surveyors visit the practice and obtain information on a systematic random sample of visits.

They collect data of visit characteristics such as the major reason for visit, physician’s diagnosis, and diagnostic and therapeutic services ordered or provided during the visit.

Surveyors also interview the physicians and collect data on practice characteristics.

Records of patient’s visits to physicians associated with a diagnosis of knee OA were identified. Then, assessed whether the physician prescribed:

• Osteoarthritis knee Physical Therapy,
• Provided advice on exercise and/or weight reduction strategies, and/or
• Prescribed pain medications during the visit.

Other extracted data included physician characteristics such as specialty (i.e., orthopedist, or medical specialties such as internal medicine or family medicine, or other), whether the physician seen was the patient’s primary provider, and whether the patient was seen by an advanced practice provider (i.e., nurse practitioner or physician assistant).

Result

A total of 2297 knee OA related visits were identified between 2007 and 2015. Among these visits, 66% of visits were to orthopedic surgeons and 21% were to Primary Care Physicians (PCPs), and the remainder were to other specialists.

A higher proportion of visits for an acute problem were prescribed NSAIDs and a higher proportion of surgical visits were prescribed PT.

Results concluded from 2007 to 2015, number of visits for physical therapy, orthopedists and for lifestyle recommendations declined considerably. No change, however, was observed among visits to primary care physicians.

Furthermore, although there was no significant change in the number of physical therapy and narcotics prescriptions, prescriptions for nonsteroidal and anti-inflammatory increased.

Conclusion of research

Based on the study, scientists could infer that patients did not receive optimum care for knee osteoarthritis. It was further observed that physicians were more concerned to manage the patient’s pain with medications. Experts, however, suggest that long-term benefits of exercise were equally important to mitigate declines in physical health.

The study concludes that although an increase in non-narcotic medication was expected as part of standard treatment protocols, the growth in narcotic prescriptions was concerning and required attention.

As an OA knee sufferer, what should you do?

As an osteoarthritis knee sufferer, you should focus more on exercises and lifestyle modification.

Lifestyle modifications include avoiding pain aggravating activities such as:

• Squatting.
• Crossed leg sitting.
• Stair climbing.

In addition to this, make a habit of doing arthritis knee exercises once or twice daily. I have already discussed in detail all the exercises one can benefit from in this article “Exercises for arthritis in knee for pain relief“. You can read this article and follow the exercises, such as:

• Static quadriceps exercises.
• Straight leg raise exercises.
• Pillow press exercise..etc

Reference:

1. Samannaaz S. Khoja, Gustavo J. Almeida, Janet K. Freburger. Recommendation Rates for Physical Therapy, Lifestyle Counseling and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings. Cross‐sectional Analysis of the National Ambulatory Care Survey (2007‐2015). Arthritis Care & Research, 2019; DOI: 10.1002/acr.24064