File
van Doormaal M1, Peter W2, Vliet Vlieland T2, Meerhoff G1
1Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, Netherlands, 2Leiden University Medical Centre, Leiden, Netherlands
Background: Until 2018, the most recent update of the physical therapy guideline Osteoarthritis of the Hip and Knee was conducted in 2010. Since then, scientific developments changed the view on osteoarthritis and could have significant impact on daily practice. For example, exercise therapy is widely accepted as an effective conservative treatment.
Purpose: Because the increased evidence of effectiveness of physical therapy in patients with osteoarthritis of the hip and knee and the need for implementation in daily practice, an update of the guideline was necessary with more applicable recommendations about the content of exercise therapy.
Methods: To develop more practical and widely supported guidelines, a guideline methodology was developed by the Royal Dutch Society for Physical Therapy (KNGF) in 2016. This methodology was based on GRADE, the most accepted approach in guideline development worldwide. According to the KNGF methodology, a guideline panel was formed out of 22 stakeholders, e.g. physical therapists, general practitioners, orthopedic surgeons, patient representatives and healthcare insurers. Based on the scientific evidence and other considerations, the guideline panel formulated the recommendations in this guideline.
Results: Recommendations about diagnostics and therapeutic interventions formed the base of the new Dutch guideline Osteoarthritis of the Hip and Knee. Three indications were formulated, based on patient preferences, severity of the functional condition and existence of comorbidity. A fourth indication concerned pre- and postoperative physical therapy before or after a total joint replacement. It was recommended to restrict physical therapy in patients with minor functional limitations by informing and advising about osteoarthritis and how to deal with the disease. In contrast, extensive supervised exercise therapy was recommended in patients with severe functional restrictions and/or comorbidity. Besides informing and advising, supervised exercise therapy is stated as the intervention with the strongest recommendation. Frequency, Intensity, Type and Time (FITT factors) of exercise therapy are described extensively, based on evidence and strongly linked to (inter)national recommendation for physical activity. Besides informing and advising, other non-exercise therapeutic interventions were not recommended.
Conclusion(s): The new guideline Osteoarthritis of the Hip and Knee provides practical information and guidance to physical therapists on diagnostics and therapeutic interventions. Extensive implementation is necessary to enhance conservative treatment of osteoarthritis and achieve uniform health care.
Implications: Implementation of the guideline has already started by offering e-learning and training to physical therapists. Additionally, the content of the guideline is communicated through several journals for healthcare professionals. A widely supported and implemented guideline will contribute to more effective and uniform treatment strategies in physical therapists and other healthcare professionals.
Keywords: Osteoarthritis, Guideline, Exercise
Funding acknowledgements: Development of this guideline was funded by the KNGF
Purpose: Because the increased evidence of effectiveness of physical therapy in patients with osteoarthritis of the hip and knee and the need for implementation in daily practice, an update of the guideline was necessary with more applicable recommendations about the content of exercise therapy.
Methods: To develop more practical and widely supported guidelines, a guideline methodology was developed by the Royal Dutch Society for Physical Therapy (KNGF) in 2016. This methodology was based on GRADE, the most accepted approach in guideline development worldwide. According to the KNGF methodology, a guideline panel was formed out of 22 stakeholders, e.g. physical therapists, general practitioners, orthopedic surgeons, patient representatives and healthcare insurers. Based on the scientific evidence and other considerations, the guideline panel formulated the recommendations in this guideline.
Results: Recommendations about diagnostics and therapeutic interventions formed the base of the new Dutch guideline Osteoarthritis of the Hip and Knee. Three indications were formulated, based on patient preferences, severity of the functional condition and existence of comorbidity. A fourth indication concerned pre- and postoperative physical therapy before or after a total joint replacement. It was recommended to restrict physical therapy in patients with minor functional limitations by informing and advising about osteoarthritis and how to deal with the disease. In contrast, extensive supervised exercise therapy was recommended in patients with severe functional restrictions and/or comorbidity. Besides informing and advising, supervised exercise therapy is stated as the intervention with the strongest recommendation. Frequency, Intensity, Type and Time (FITT factors) of exercise therapy are described extensively, based on evidence and strongly linked to (inter)national recommendation for physical activity. Besides informing and advising, other non-exercise therapeutic interventions were not recommended.
Conclusion(s): The new guideline Osteoarthritis of the Hip and Knee provides practical information and guidance to physical therapists on diagnostics and therapeutic interventions. Extensive implementation is necessary to enhance conservative treatment of osteoarthritis and achieve uniform health care.
Implications: Implementation of the guideline has already started by offering e-learning and training to physical therapists. Additionally, the content of the guideline is communicated through several journals for healthcare professionals. A widely supported and implemented guideline will contribute to more effective and uniform treatment strategies in physical therapists and other healthcare professionals.
Keywords: Osteoarthritis, Guideline, Exercise
Funding acknowledgements: Development of this guideline was funded by the KNGF
Topic: Musculoskeletal; Musculoskeletal: lower limb
Ethics approval required: No
Institution: n.a. in guideline development
Ethics committee: n.a. in guideline development
Reason not required: n.a. in guideline development
All authors, affiliations and abstracts have been published as submitted.
