Exercise, education among most strongly
recommended interventions for osteoarthritis

With incidence rates expected to rise, better evidence-based guidelines are required
Osteoarthritis (OA) is already the most prevalent form of arthritis and one of the top conditions that leads to pain and disability, yet predictions estimate OA rates are still increasing and will double by 2020. Due to the significant impairments created particularly by hip and knee OA, it can be viewed as a societal burden with negative implications on those who suffer from it and the general population. Strategies based on evidence that prove effectiveness are therefore imperative to manage OA and temper its potential impact. Though some treatments like exercise are highly recommended and supported by literature, no critical appraisal has yet been created to grade all guidelines comprehensively. To better serve this purpose, a systematic clinical appraisal was conducted to present all evidence-based recommendations on the management of OA.

Multiple databases and the Internet searched thoroughly for guidelines
A total of eight databases and the internet were searched in depth to identify any studies with pertinent data. In order to be included, studies had to contain recommended guidelines from evidence-based research, consensus and/or expert opinion. Out of 19 guidelines initially found, 17 were deemed eligible and used, which consisted of 40 interventions. Each set of guidelines was then evaluated for quality using the Appraisal of Guidelines for Research and Evaluation II, which consisted of 23 items arranged into six domains, and each item scored between 1 (strongly disagree) to 4 (strongly agree).

Exercise and education strongly supported by more guidelines than any other treatment

Interventions that were graded as “strongly recommended” included transcutaneous electrical nerve stimulation, knee bracing, wedged insoles, aquatic therapy/hydrotherapy, self-management and weight loss; however, education and various forms of exercise were consistently found at the top of the list as the most strongly-recommended interventions in the guidelines. Exercise recommendations ranged from very specific (aerobic, strength training, etc.) to much more general, but all forms of it were categorized as strongly recommended, as it led to improvements in pain and function. Education was also firmly supported by the literature, as it was found to reduce pain, increase coping skills and result in fewer visits to primary care practitioners. Furthermore, there was ample evidence that recommended prescribing individualized patient exercise and education over more generic protocols, which can further elevate the potential benefits of rehabilitation. Based on these findings, while the other interventions mentioned may be effective for managing OA, it appears exercise and education, particularly when individualized to each patient, will lead to the greatest improvements. Adopting a strategy of individualized exercise and education within any conservative OA protocol may there provide a cost-effective, cutting-edge intervention, and help in attaining optimal outcomes.

-Summarized by Greg Gargiulo
-As reported in the Feb. ’14 edition of
Archives of Physical Medicine and Rehabilitation