Conservative non-pharmacological management of knee osteoarthritis in Switzerland: there is an evidence-performance gap
L. Ettlin1, I. Nast1, E. Huber1, K. Niedermann1 (1Winterthur)
International Guidelines recommend self-management, exercise and weight management if appropriate as first line conservative treatment for patients with knee osteoarthritis (OA). The objective of this study was to survey the conservative non-pharmacological management of patients with knee OA in Switzerland and to explore perceived barriers and facilitators for the application of guideline recommendations.
Based on the results of semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons, a survey was performed across their scientific societies. Questions addressed diagnostic measures, treatment options, reasons for referral to exercise as well as barriers and facilitators.
In total, 234 members responded. They indicated that usually patients presented due to pain (n=222, 98.2%) and functional limitations of the knee (n=151, 66.8%). Additionally to clinical assessment X-ray (n=214, 95.5%) and MRI (n=70, 31.3%) were used as diagnostic measures. The referral to exercise, was driven by the patients' expectation/high level of suffering (n=73, 37.1%), as well as by their own clinical experience (n=49, 24.9%). They estimated to refer 54% of their patients to exercise. Further, the specialists rated as the most important barriers for the referral to exercise 'disinterest of patient' (n=88, 46.3%) and 'physically active patient' (n=59, 31.1%). As most important facilitators, they rated 'priority to mention exercise during short time of consultation' (n=170, 89.4%) and 'insufficiently physically active patient' (n=165, 86.9%).
Discussion et conclusions
A substantial evidence-performance gap in the management of patients with knee OA seems to be present. To successfully support systematic referral to exercise as first line intervention, it may be important to not simply suggest exercise in general, but a specific best-practice exercise and education programme for knee OA.
Importance pour la pratique
This study identified an evidence-performance gap, as the strong evidence in favour of exercise is not transferred to clinical practice. There seems to be no systematic treatment pathway in line with the clinical guidelines and thus exercise treatment for patients with knee OA may be under-prescribed in Switzerland. Strategies to close this gap and to improve the conservative management of knee OA, i.e. "exercise first", according to the international clinical guidelines are needed.