New research found that clinicians who care for patients with osteoarthritis (OA) are likely not following standard care guidelines that are based on current medical evidence. Researchers noted physicians were prescribing medications for pain and inflammation, or opting for surgical interventions rather than recommending weight loss plans or exercise programs to OA patients.
David Hunter, MD from the University of Sydney in Australia and New England Baptist Hospital in Boston and colleagues reviewed how standard clinical practice diverges from evidence-based recommendations in the management of OA.
“We present a potential roadmap for optimizing the quality of OA health care for those developing and enforcing policy decisions, and for clinicians on the frontlines of OA management to enact practice change,” Hunter stated in a press release.
Current clinical practice does not reflect recommendations based upon medical evidence. The authors report that therapeutic interventions are primarily aimed at reducing pain and improving joint function by using therapies that target symptoms, but do not facilitate improvement in joint structure or long-term betterment of the disease. Frequently, physicians do not recommend conservative non-pharmacologic management therapies which leads to unnecessary diagnostic imaging and inappropriate referrals to orthopedic surgeons.
“Weight management and exercise programs tend to be overlooked by clinicians,” Hunter stated. “These conservative approaches are beneficial to patients who adhere to weight-loss and exercise programs.”
Researchers further suggest that surgery be resisted when symptoms can be well managed by other treatment methods. The typical indications for a surgical approach in treating OA are debilitating pain and major limitation of functions such as walking, working or sleeping. However, prior studies have shown that up to 30% of some surgical procedures are inappropriate and recent recommendations suggest routine arthroscopy for knee OA management should be avoided — something not reflected in clinical practice.
“Eliminating unproven procedures and reducing needless costs is necessary to improve the quality and lower the cost of healthcare in the United States,” Hunter stated. “The management of OA should focus on a patient-centered and provider integrated approach that improves quality and reduces cost by following evidence-based recommendations.”