Recommendation Rates for Physical Therapy, Lifestyle Counseling, and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings: A Cross‐Sectional Analysis of the National Ambulatory Care Survey (2007–2015)

Abstract

Objective. To describe and compare triennial rates of physicians' recommendations for physical therapy (PT), lifestyle counseling, and pain medication for knee osteoarthritis (OA) and to identify patient, physician, and practice factors associated with each treatment recommendation.Methods. We conducted a cross-sectional analysis examining data between 2007 and 2015 from the National Ambulatory Medical Care Survey. Visits to orthopedists and primary care physicians for knee OA were identified and assessed for the following: PT referral, lifestyle counseling, nonsteroidal antiinflammatory drug (NSAID) prescriptions, and narcotics prescriptions. Triennial rates for each treatment were calculated. We examined associations between patient (e.g., race, insurance), physician, and practice factors (e.g., ownership, location) and treatments prescribed using multivariate logistic regression that accounted for complex sampling design.Results. A total of 2,297 physician visits related to knee OA (~67 [±4] million weighted visits) were identified. For visits to orthopedists, PT and lifestyle recommendation rates declined (158 to 88 of 1,000 visits and 184 to 86 of 1,000 visits, respectively), while NSAID and narcotics prescriptions increased (132 to 278 of 1,000 visits and 77 to 236 of 1,000 visits, respectively) over time (P < 0.05). For visits to primary care physicians, there were no significant changes in rates of PT, lifestyle counseling, and narcotics prescriptions over time, while NSAIDs prescriptions increased (221 to 498 of 1,000 visits; P < 0.05). Treatment recommendations were associated with nonclinical factors, including practice type, location, and type of provider.Conclusion. In patients with knee OA, PT and lifestyle counseling seem underutilized, while pain medication prescriptions increased during the investigated timeframe. Variation in treatment choices were associated with nonclinical factors. Future research is necessary to examine ways to improve PT and lifestyle utilization and reduce variation in care for knee OA.

Pain during walking and ascending stairs before hyaluronic acid injection was common in patients with knee osteoarthritis: a qualitative study

“…However, only 9.4% of those surveyed reported that exercise program was recommended as a treatment in our study. These findings are consistent with previous reports on low-rate recommendation of exercise, noncompliance to exercise therapy and lifestyle counseling, and warrant further investigation to increase this low level of adherence [31,32]. The most appropriate knee OA management, including exercise therapy, should be designed according to a patient-centered approach.…”

Treatment Efficacy of Single Topical NSAID (S-Flurbiprofen Plaster) for Knee Symptoms and Locomotive Dysfunction in Knee Osteoarthritis Patients

“… 5 ) Pain control is important when performing exercise, and it was revealed that about half of the patients receiving physical therapy used non-steroidal anti-inflammatory drugs (NSAIDs). 6 ) Topical NSAIDs are the most strongly recommended treatment modality according to the latest Osteoarthritis Research Society International (OARSI) guidelines, whereas oral NSAIDs are conditionally recommended. 5 )…”

“I've been to physical therapy before, but not for the knees.” A qualitative study exploring barriers and facilitators to physical therapy utilization for knee osteoarthritis

“…Our findings were consistent with other published studies that a lack of referral results in underutilization of OA health services. (Cottrell, Roddy, & Foster, 2010;Hagglund, Clark, Hilton, & Hewett, 2005) Recommendation rates for PT for knee OA by physicians have declined by nearly 50% from 2007 to 2015 (Khoja, Almeida, & Freburger, 2019), which is concerning given our study's findings highlighting the importance of physician referrals and evidence for nonsurgical knee OA treatments (Hochberg et al, 2012). Further research is needed to develop and implement practical strategies to improve physician referral patterns to PT for knee OA.…”