Fernandes, Linda2; Hagen, Kare B.2; Bijlsma, Johannes W.J.3; Andreassen, Oyvor4; Christensen, Pia20; Conaghan, Philip G.5; Doherty, Michael6; Geenen, Rinie7; Hammond, Alison8; Kjeken, Ingvild2; Lohmander, L. Stefan9; Lund, Hans10; Mallen, Christian D.11; Nava, Tiziana12; Oliver, Susan13; Pavelka, Karel14; Pitsillidou, Irene15; da Silva, Jose Antonio16; de la Torre, Jenny17; Zanoli, Gustavo18; Vlieland, Theodora P.M. Vliet19
1 Obesity Research, Department of Nutrition, Exercise and Sports, Faculty of Science, Københavns Universitet2 National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo3 Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht4 Department of Rheumatology, Patient Panel, Diakonhjemmet Hospital, Oslo5 Division of Musculoskeletal Disease, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds6 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham7 Department of Clinical and Health Psychology, Utrecht University, Utrecht8 Centre for Health Sciences Research, University of Salford, Salford9 Department of Orthopaedics, Clinical Sciences Lund, University of Lund, Lund10 Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics University of Southern Denmark, Odense11 Arthritis Research UK Primary Care Centre, Keele University, Keele12 Faculty of Physiotherapy, University of Studies of Milan, Milan13 Nurse Consultant Rheumatology, Minerva Health Centre, Preston14 Institute of Rheumatology and Clinic of Rheumatology, First Medical Faculty, Charles University, Prague15 Cyprus League Against Rheumatism, Cyprus16 Department of Rheumatology, Centro Hospitalar Universitário de Coimbra, Coimbra17 Rheumatology Department, Alicante General and University Hospital, Alicante18 Università degli Studi di Ferrara Casa di Cura SM Maddalena, Ferrara19 Department of Orthopaedics, Leiden University Medical Center, Leiden20 Obesity Research, Department of Nutrition, Exercise and Sports, Faculty of Science, Københavns Universitet
The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
Annals of the Rheumatic Diseases, 2013, Vol 72, Issue 7, p. 1125-1135