Need to Adopt a Patient Centered Approach for Obtaining Favourable Results of NonPharmacological Interventions among Knee Osteoarthritis Patients in Out Patient Department Settings

Abstract

Knee osteoarthritis (KOA) is one of the common causes of disability. Long-term effects of early to moderate KOA can be managed through non-surgical interventions. But due to overcrowding in Orthopaedic OPDs, doctors don't have enough time for explaining non pharmacological interventions (NPIs) in detail to KOA patients. Hence, desired impact of NPIs is not evident among KOA patients. This study elaborates the degree of patient centered approach adopted during doctor patient interactions in the Orthopedics OPD of a tertiary care hospital of India. The study was conducted in 2012-2015. Eligible KOA patients (N=123) were divided into two groups for the RCT. The patients aged 40-65 years of either gender without significant deformity or co-morbidities needing surgery (e.g. meniscus tears etc) were enrolled. An intervention room was established in Physical and Rehabilitation Medicine (PRM) department of the hospital. Doctors of Orthopaedics and PRM departments were requested to send grade 1, 2, 3 KOA patients as per Kellgren Lawrence scale to intervention room after initial work up. A referral system was established for this. Interviews of the diagnosed patients (N=31) suffering from mild and moderate KOA were conducted. Textual analysis was done for qualitative data. Patients are unable to comprehend 'capsule form' of advice provided in OPDs. This results in non-adherence. For better outcomes physicians must talk to patients. They need to understand the patient's underlying concerns, against their cultural background, and life history. Hence, patient centred approach is needed for obtaining the desired impact of NPIs in KOA patients reporting to Orthopaedics OPD in Indian hospitals.

Treatment-seeking Behavior of Knee Osteoarthritis Patients in Northern India

“…The Health Belief Model proposes that people are likely to engage in a given health-related behavior when they believe the problem or disease could have serious consequences on their daily living activities or when they believe the consultation with a physician or intervention would be effective. 5 In the current study, KOA patients preferred to take home remedies prior to consultation with any physician. Most of the patients kept on trying different treatments with the expectation that it would reduce pain.…”

“…Most KOA patients find it hard to incorporate changes in their lifestyle as this requires a lot of efforts and commitment. 5 Poor adherence to therapy results in worsening of their condition over time. As the pain and discomfort due to KOA increases, person's mobility gets restricted further.…”

“…The management of long-term effects of KOA can be through nonsurgical interventions. 5 Surgical options, viz., tibial osteotomy and arthroplasty are costly option and are mainly for people with severe KOA who are unresponsive to nonsurgical management. 6 In the search of relief from symptoms, patients suffering from mild/moderate KOA visit various health agencies.…”