Developing a minimum standard of care for treating people with osteoarthritis of the hip and knee

We reviewed three recently published guidelines for the management of osteoarthritis (OA) and considered the evidence and potential for implementation. From this we propose a minimum standard of care, or a ‘core set’ of interventions, that should be offered to all patients with OA of the hip and/or knee. Eight core recommendations emerged where it is recommended that health-care professionals:

•Provide advice about, and offer access to appropriate information for OA self-management and lifestyle change

•Provide advice about weight loss if patient is overweight or obese and refer to services as required

•Provide advice for land-based exercises incorporating aerobic and strengthening components and refer to services as required

•Recommend adequate paracetamol for pain relief

•Make patients aware that non-steroid anti-inflammatory drugs (NSAIDs) or coxibs can improve symptoms in majority but this comes with potential for harm and that risk potential varies – be aware of and minimise the individual's risk potential

•Offer intra-articular steroids for short-term relief of a flare or acute deterioration in symptoms.

•Offer stronger analgesic relief if prolonged severe symptoms

•Offer access to assessment for arthroplasty for consumers with severe symptomatic OA not responding to conservative therapy

An integrated, chronic disease model of care is proposed to best implement OA management and a check list of clinical indicators/performance measures is provided.

Keywords: osteoarthritis knee, osteoarthritis hip, clinical practice guidelines, model of care, evidence-based practice, clinical indicators

a Institute of Bone and Joint Research, University of Sydney, Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia

b Clinical Epidemiology and Health Services Evaluation Unit (CEHSEU), The Royal Melbourne Hospital, Melbourne Health, Royal Park Campus, 34-54 Poplar Road, Parkville, VIC 3052, Australia

c Public Health Innovation, Deakin University, Burwood Campus, 221 Burwood Highway, Melbourne, VIC 3125, Australia

d Centre for Research Excellence in Patient Safety (CREPS), Monash University, Australia

e Department of Medicine, University of Melbourne (Hon.), Royal Park Campus, 34-54 Poplar Road, Parkville, VIC 3052, Australia

Corresponding author. Tel.: +61 2 9923 7351; Fax: +61 2 9906 1859.

1 Tel.: +61 3 9342 8772x72761; Fax: +61 3 9342 7060.

2 Tel.: +61 3 9244 6999; Fax: +61 3 9244 6624.

3 Tel.: +61 3 9342 8772; Fax: +61 3 934 27060.

PII: S1521-6942(09)00122-3

doi:10.1016/j.berh.2009.10.002

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