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Y. van Zaanen1, A. Hoorntje2,3,4, K.L. Koenraadt2, L. van Bodegom-Vos5, G.M. Kerkhoffs3,4, S. Waterval-Witjes6,1,2, T.A. Boymans7, R.C. van Geenen2, P.P.F. Kuijer1
1Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands, 2Amphia Hospital, Department of Orthopaedics, Breda, Netherlands, 3Amsterdam UMC, University of Amsterdam, Orthopaedic Research Center Amsterdam, Amsterdam, Netherlands, 4Amsterdam UMC, University of Amsterdam, Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, Netherlands, 5Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, Netherlands, 6Personalized Knee Care, Maastricht, Netherlands, 7Maastricht University Medical Center, Department of Orthopaedic Surgery, Maastricht, Netherlands
Background: Guidelines for knee osteoarthritis (OA) advise extensive non-surgical treatment to delay surgery. Yet, the actual utilization of non-surgical treatment in hip and knee OA patients prior to arthroplasty in the Netherlands is only described by a cohort study from 2013.
Purpose: We evaluated how many knee OA patients received non-surgical treatment before surgery, including exercise-based therapy, and assessed patient satisfaction regarding symptoms and participation in activities of daily life (ADL), work and sport/leisure time.
Methods: A multi-centre questionnaire study was performed among knee OA patients that were listed for or had recently undergone knee surgery. Questions concerned received non-surgical treatment according to the Dutch Stepped Care Strategy consisting of Step 1; acetaminophen, education and lifestyle advice, Step 2; exercise-based therapy, NSAIDs, dietary therapy and tramadol and Step 3; intra-articular injection. Satisfaction with received treatments was rated from 1 (very unsatisfied) to 10 (very satisfied) and ≥6 was labelled as ‘satisfied’. Satisfaction rates were enquired concerning pain, swelling, stiffness, activities of daily life (ADL), work and sport/leisure time. A sensitivity analysis was performed for patients with paid employment at the time of surgery.
Results: The questionnaire was completed by 92 of 112 eligible patients (82%). Mean age was 65 years, 62% female, 87% were overweight and 33% had paid employment. Acetaminophen, education and lifestyle advice (Step 1) were most received by patients (62-79%). Of Step 2 exercise-based therapy was most received, by 59% of patients followed by NSAIDs, dietary therapy and Tramadol, received by 19-52%. Intra-articular injection (Step 3) was received by 47% of patients. Patients were mostly satisfied with NSAIDs, exercise-based therapy and intra-articular injection for pain and ADL. Patients with paid employment were most satisfied with NSAIDs (56%) and intra-articular injection (54%) for work participation and less with exercise-based therapy (35%).
Conclusion(s): Among all knee OA patients NSAIDs, tramadol, exercise-based therapy and intra-articular injection seem underutilized because of their positive effect on pain and activities of daily life. Among working knee OA patients NSAIDs and intra-articular injection seem underutilized because of their positive effect on work participation. Better insight in patients’ satisfaction regarding treatment effects on symptoms and participation could support better adherence.
Implications: Exercise-based therapy can be utilized more given the positive effect on pain and activities of daily life in the Netherlands.
These data on satisfaction with treatment effects regarding symptoms and participation are helpful in guiding a patient centred journey, in which physiotherapy is just one of the treatments.
Recognizing the difference in effect of exercise-based therapy regarding symptoms versus participation can support physiotherapists to focus more on treatment effects regarding participation, especially work participation, and thereby facilitate better adherence.
These data on satisfaction with treatment effects regarding symptoms and participation are helpful in guiding a patient centred journey, in which physiotherapy is just one of the treatments.
Recognizing the difference in effect of exercise-based therapy regarding symptoms versus participation can support physiotherapists to focus more on treatment effects regarding participation, especially work participation, and thereby facilitate better adherence.
Funding, acknowledgements: This project received funding from the Netherlands Organization for Health Research and Development (ZonMw) (reference number 516000503).
Keywords: Knee Osteoarthritis, non-surgical treatment, vocational rehabilitation
Topic: Occupational health & ergonomics
Did this work require ethics approval? No
Institution: Amsterdam UMC
Committee: METC Amsterdam UMC, Location AMC
Reason: Medical Research Involving Human Subjects Act (WMO) did not apply to this study (reference number W17_325 #17.378).
All authors, affiliations and abstracts have been published as submitted.
