Conservative non-pharmacological management of knee osteoarthritis in Switzerland: a survey among medical specialists

Abstract

Background: International Guidelines recommend self-management, exercise and weight management if appropriate as first line conservative treatment for patients with knee osteoarthritis (OA). The objective of this study was to survey the conservative non-pharmacological management of patients with knee OA in Switzerland and to explore perceived barriers and facilitators for the application of guideline recommendations. Methods: Based on the results of semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons, a survey was performed across their scientific societies. Questions addressed diagnostic measures, treatment options, reasons for referral to exercise as well as barriers and facilitators. Results: In total, 234 members responded. They indicated that usually patients presented due to pain (n=222, 98.2%) and functional limitations of the knee (n=151, 66.8%). Additionally to clinical assessment X-ray (n=214, 95.5%) and MRI (n=70, 31.3%) were used as diagnostic measures. The referral to exercise, was driven by the patients’ expectation/high level of suffering (n=73, 37.1%), as well as by their own clinical experience (n=49, 24.9%). They estimated to refer 54% of their patients to exercise. Further, the specialists rated as the most important barriers for the referral to exercise ‘disinterest of patient’ (n=88, 46.3%) and ‘physically active patient’ (n=59, 31.1%). As most important facilitators, they rated ‘priority to mention exercise during short time of consultation’ (n=170, 89.4%) and ‘insufficiently physically active patient’ (n=165, 86.9%). Conclusion: A substantial evidence-performance gap in the management of patients with knee OA seems to be present. To successfully support systematic referral to exercise as first line intervention, it may be important to not simply suggest exercise in general, but a specific best-practice exercise and education programme for knee OA.

The feasibility, facilitators, and barriers in the initial implementation phase of ‘good life with osteoarthritis in Denmark’ (GLA:D®) in Switzerland: a cross-sectional survey

“…Based on consistent and high-quality evidence for its effectiveness and safety, international clinical guidelines recommend patient education, exercise, and weight management, if appropriate, as first-line treatment for hip and knee OA [ 5 – 8 ]. However, investigations in many countries indicate that the transfer of these guideline recommendations into clinical practice, and therefore, the conservative, non-pharmacological management of hip and knee OA, is insufficient [ 9 – 13 ]. Also in Switzerland, this evidence-performance gap is present [ 14 ].…”