Non-pharmacological OA.docx

What do physiotherapists do this is outlined below? History Physical exam Functional assessment (gait, stairs, balance, agility, etc.) Shared goal setting & develop self-management strategies incl. ‘pain toolbox’ Prescribe therapeutic exercise & physical activity guidance Adjunctive manual t...

What do physiotherapists do this is outlined below? History Physical exam Functional assessment (gait, stairs, balance, agility, etc.) Shared goal setting & develop self-management strategies incl. ‘pain toolbox’ Prescribe therapeutic exercise & physical activity guidance Adjunctive manual therapy, electrophysical agents, taping & bracing What do Occupational therapists do. This is outlined below: History & physical exam with focus on participation, ‘occupations’ & ADL (self care) Shared goal setting Joint protection (splints, orthoses, footwear) Energy conservation Adaptive equipment & ergonomics (for work, home, school, leisure) OARSI Guidelines-2019 outlined below: Core Treatments outlined below: Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management Hip and polyarticular OA included arthritis education and structured land-based exercise programs Level 1B: Conditional recommendations for aquatic exercise, gait aids and self-management programs; mind-body exercise for poly OA Level 2: Low consensus ‘in favour of’ cognitive behavioural therapy with exercise for hip and knee OA Weight management. Is it recommended? HQO Quality Statement 7: Weight Management People with OA who are overweight or obese are offered patient-centred weight-management strategies, and people at a normal weight are encouraged to maintain their weight. AAOS 2021 - Sustained weight loss is recommended to improve pain and function in overweight and obese patients with knee osteoarthritis ★ ★ ★ NICE 2022 – Advise to lose weight, support them to choose a weight loss goal, aim for 10% EULAR 2023 - Education on importance of maintaining a healthy weight/support to achieve & maintain weight loss Electrophysical modalities are they recommended? ACR 2019-conditionally recommends thermal (heat, cold, paraffin) & acupuncture; strongly against TENS OARSI 2019-conditionally against heat, acupuncture, ultrasound AAOS 2021-limited recommendation for TENS, LLLT, acupuncture, PEMF and extracorporeal shock wave therapy NICE 2022 – do not recommend ANY electrotherapy Treatments Manual therapy is it recommended? ACR 2019- conditionally against massage, manual therapy with exercise OARSI 2019-conditionally against mobilization & manual therapy AAOS 2021 – limited recommendation for manual therapy and massage as adjuncts to exercise program to improve pain and function in knee OA NICE 2022 – as adjunct to exercise only Systematic review 2022 – very low to moderate certainty evidence that MT provided short-term benefit for pain & global WOMAC score compared to exercise alone for hip/knee OA Walking aids. Are they recommended? EULAR 2023 recommends assistive devices (cane) ACR 2019 strongly recommends use of cane for knee/hip OA when sufficiently large impact on ambulation, joint stability, or pain OARSI 2019 conditionally recommends NICE 2022 conditionally recommend ~12% ↓ GRF with both contra/ipsilateral cane use (Fang MA et al. PMR 2015) ↓medial knee load with contra cane use (Simic M et al. Osteo Cartilage 2011) Supporting 20% BW thru cane results in up to 40% ↓ hip joint loads Walking poles (Urban poles™) have not been found to ↓knee joint loads or adductor moments (Bechard DJ et al. Osteo Cartilage 2012) Walking poles-good option for patients not ready to “embrace” a cane & can improve balance! Bracing & taping. Is it recommended? AAOS 2021 – moderate recommendation to use brace treatment ACR 2019-strongly recommends TF knee braces when OA has sufficiently large impact on ambulation, joint stability, or pain to warrant use & conditionally recommend PF braces OARSI 2019-conditionally recommends against varus/valgus unloading brace NICE 2022-conditionally recommends ACR 2019 & NICE 2022-conditionally recommend kinesiotaping for knee OA Foot orthoses. LATERAL WEDGE INSOLES ARE BAD!!!! Limited evidence that a laterally wedged insole > no treatment Moderate evidence that a laterally wedged insole = neutral insole for pain, function and stiffness. Duivenvoorden T, et al. Cochrane Database Sys Rev 2015;3:CD004020 ACR 2019 – conditional recommendation against wedged insoles AAOS 2021 – strong recommendation against LWI NICE 2022 – conditional recommendation for insoles (no mention of LWI) EULAR 2023 – no evidence to support LWI proper foot wear is recommended