This is an interesting report on how we should be approaching the rising problem of osteoarthritis (OA). Although this study is done into knee OA treatment it really does apply to any joint and if all the health professions could get over themselves and use a multi disciplinary model the patients would be much better off!
This Canadian study on knee OA treatment was reported Doctors Lounge. It used community based pharmacists as the lead off people. I think this is a great idea or perhaps use nurses to co-ordinate the plan of management.
The study consisted of:
a validated knee OA screening questionnaire, education, pain management, physical therapist-led exercise, and communication with the primary care doctor, while usual care was an educational pamphlet.
You might laugh at the educational pamphlet but how many people have contacted me saying their Doctors gave them that and some pain killers and told them it was normal at their age! If it was normal ALL their joints would be worn out!
These were the results:
The researchers found that, compared with the control arm, the overall quality indicator pass rate was significantly higher in the intervention group (difference of 45.2 percent). At three and six months, the intervention care group experienced significant improvements in the Western Ontario and McMaster Universities Osteoarthritis Index global, pain, and function scores; the Paper Adaptive Test-5D (PAT-5D) daily activity scores; and the Health Utilities Index Mark 3 single-attribute pain score. At six months, improvements were noted in the PAT-5D pain scores and the Lower Extremities Function Scale scores.
“These results suggest that community pharmacists can effectively launch a multidisciplinary intervention to address the gaps in OA patient care, including identification and utilization of pharmacological and non-pharmacological treatment options,” the authors write. “Considering the rising prevalence of OA and the associated personal and societal costs, these findings have important implications for efficient referral to prevention and intervention programs.”
What is the Most Important Part of this Knee OA Treatment?
There is actually not one thing that is better than another. You need all these components of this multi disciplinary approach for effective knee OA treatment.
1. Screening questionnaire: everybody’s OA affects them differently. Knee OA treatment should be specifically designed for the person.
2. Education: understanding both the actual condition and WHY you need each part of the knee OA treatment plan is important. There are no short cuts unfortunately.
3. Pain management: no matter how good your knee OA treatment is you will get some pain sometimes as you cannot cure the actual wearing of the cartilage . You need to know what to do when you get pain and prevention techniques to reduce the frequency and severity of the pain.
4. Physical therapist-led exercise: exercises are not simply taking a walk (though that has health benefits!) it means doing a targeted program of exercise for your knee OA. It is the only actual treatment that will improve the condition by improving joint function. The rest of these knee OA treatment you are chasing symptoms of the condition.
5. Communication with the primary care doctor: you may need prescription based pain medication and eventually onward referral to a surgeon. Open the line of communication so he has a record of what is happening.
What Will This Knee OA Treatment Cost?
This type of multi disciplinary approach to knee OA treatment does not have to cost the earth. It is the approach I have taken for years and it is the same approach I use for all my Joint Control clients. The most expensive thing is the physical therapy as most therapists will not teach you how to treat yourself and you need the hands on part of the therapy (e.g. massage or TENS) as well as the exercises that they should give you to do at home.
Since starting Joint Control as an Internet program on 29th March 2012 these are the stats:
159 massage and exercise programs done.
3 people got less than 50% pain relief,
5 dropped out and failed to get to maintenance. It takes approximately 15 to to 20 minutes per day in weeks 3 and 4. Then it reduces and by week 6 or 7 you are doing 15 to 20 minutes three times a week (maintenance).
1 lady fell on her bad hip and broke it so it had to be replaced in week 3. She reports she was improving though!
8 failed to respond to my questionnaire so I don’t know how they got on!
If I assume those 8 didn’t do well that is still 142 people out of 159 that got 50% or more pain relief. They also reported improved quality of life and being able to do more of the things they enjoy.
That is an 89.3% success rate and I believe it shows you can get good OA pain relief without breaking the bank- as long as you are prepared to make the commitment and do a little work.
This is what one lady added to the bottom of her questionnaire about her Joint Control knee OA treatment:
I have OA in my right knee. X-rays showed the inside of my knee was very worn but the outside was OK. My GP wanted me to get a half knee replacement. However I have a big trip planned in October and I did not have time to get this done and recover before then. I started my program on May 23 within 4 weeks all the nagging pain had gone. I get occasional sharp pain if I twist on my knee so I try not to do that!
My Doctor is amazed at how well I have done. I am now looking forward to my grand tour and know that with the techniques you has taught me I can manage my knee pain. I am so looking forward to walking around all the cathedrals and exploring and experiencing Italy in a way I couldn’t have imagined a few months ago. Thank you so much! – Emma from Scotland
Joint Control takes a multi disciplinary approach. If you want a comprehensive knee OA treatment plan with someone to help and advise you along the way click here.
UPDATE AUGUST 2013
There is now another version of Joint Control. You can read about it here.