Physical therapy (PT) and lifestyle interventions remain underused in the management of knee osteoarthritis (OA), while reliance on drug treatment has been increasing, a nationwide survey found.

The rate of referral to PT by orthopedic specialists fell from 158 per 1,000 visits in the years 2007-2009 to 86 per 1,000 visits in 2013-2015 (β = -0.012, P=0.013), and lifestyle counseling was offered in 184 per 1,000 visits in 2007-2009, but in only 88 per 1,000 in 2013-2015 (β = -0.020, P=0.018), according to Samannaaz S. Khoja, PT, PhD, of the University of Pittsburgh, and colleagues.

And at those same time points, rates of prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) during visits to orthopedic specialists more than doubled from 132 per 1,000 visits to 278 per 1,000 (β = 0.19, P=0.017), while prescriptions for narcotics tripled, from 77 per 1,000 visits to 236 per 1,000 (β = 0.021, P=0.001), they reported in Arthritis Care & Research.

These trends suggest “that knee OA is primarily managed from a perspective of symptom control and not from the perspective of improving physical function, fitness, and overall well-being,” the researchers wrote.

“Physicians seem more focused on helping their patients manage their pain with medications, which includes both NSAIDs and narcotic medications,” Khoja told MedPage Today. “However, it is important to consider the long-term benefits of lifestyle interventions, such as weight management, exercise, and PT, for mitigating declines in physical health and reducing dependence on medications.”

The prevalence of knee OA in the U.S. has risen dramatically in recent years, from 9 million in 2005 to 15 million in 2012, and costs have increased accordingly.

Clinical practice guidelines, available for more than 20 years, have emphasized the importance of PT and lifestyle changes including exercise and weight loss as first-line treatment strategies.

“Management of knee OA through physical therapy or lifestyle counseling may reduce overall healthcare utilization by minimizing the continuous need for pain medication and delay the need for knee surgery and other invasive procedures (e.g., intra-articular injections),” Khoja and colleagues wrote.

However, these approaches are not necessarily physician-driven, and patients who seek treatment from either orthopedic specialists or primary care physicians may be treated largely pharmacologically — despite the realization that pain medications are not likely to affect disability. Little is known, however, about actual patterns of physician referral, advice, and prescription use for these patients.

The researchers analyzed data from the National Ambulatory Medical Care Survey database, which conducts an annual survey …read more

Source:: Daily Times


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