Physical Therapy and Hip/Knee Osteoarthritis
This article was reviewed by Lucie M, DPT.
What is OA?
Osteoarthritis (OA) is a chronic condition that commonly affects load bearing joints such as hips and knees and often leads to joint replacement surgeries. In the past decade there has been an exponential rise of OA and subsequentially joint replacements which is correlated to the increase in the geriatric population as well as the increase of obesity rates.
Management of OA
Evidence supports that a multidisciplinary approach is the best way to treat OA, involving specialists such as general practitioners, rheumatologists, physical therapists, and orthopedic surgeons. Clinical guidelines exist for the management of OA for both pre and post operatively as well as prevention, however there continues to be difﬁculty with implementing non-invasive treatments due to the lack of understanding of what is within the scope of Physical Therapy (PT) when treating those with OA. In the most recent issue of The Journal of Orthopedic and Sports Physical Therapy (JOSPT) Pek Ling Teo et al. identiﬁes and prioritizes the most important PT treatments when managing those with hip and/or knee OA. Physical Therapy Recommendations In the article “Identifying and Prioritizing Clinical Guideline Recommendations Most Relevant to Physical Therapy Practice for Hip and/or Knee Osteoarthritis” a consensus method involving 132 physical therapists from around the world assisted in surveying the most used and the most important PT treatments for OA.
The ﬁnal ranked list of PT interventions was then grouped by content into 6 categories.
The categories along with the highest ranked interventions within each category is listed below: 1. Principles of Treatment Planning/Delivery 1. Discuss and offer personalized exercises and a physical activity program according to the needs, preferences, self-motivation, and ability to perform exercises. Most appropriate programs involve strengthening, aerobics, and water-based activities. 2. Diagnosing and Assessment 1. Assess the effects of OA on the person’s function, quality of life, occupation, mood, relationships, and leisure activities. Be considerate of health education, health beliefs, and motivation to self-manage. 3. Physical Therapy Core Treatments 1. Patient education on activity and exercise. Intervention for weight loss if appropriate. 2. Teach regular individualized exercise regimen that includes sustained isometrics for both the knee and hip girdle. 3. Discuss weight loss strategies. 4. Adjunctive Physical Therapy Treatments 1. Recommend the use of walking aides to increase participation in activity. 5. Review and Referral 1. Refer when appropriate. 6. Communication essentials 1. Agree on a plan with the patient and the caregiver that is patient centered.
PT has a pivotal role in the management of OA. When performed properly and in adjunct with other specialist PT can assist with pain reduction, function, and improving quality of life. The best PT strategies include an in-depth assessment of the patient including patient goals and motivation, involving the patient in the planning and execution of the plan, and being consistent with the planned interventions consisting of strengthening and aerobics. It has been shown that there is connection between obesity and OA, therefore implementing a weightless program is essential when appropriate and in order to be effective in implementing a weight loss program open dialogue between therapist and the patient is essential. Therefore, the best way to help your patient is to understand your patient!