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On the waiting list for joint replacement for knee osteoarthritis: Are first-line treatment recommendations
A Cronström1,2,3, H Nero1, L S Lohmander1
1Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Insights
Guideline-based osteoarthritis treatments were underutilized before and during knee replacement waitlists in Sweden. Women participated more, but overall access and recommendations for treatments like physiotherapy were limited, indicating potential care inequalities.
Area of Science:
- Orthopedics
- Rheumatology
- Public Health
Background:
- Osteoarthritis (OA) management guidelines recommend first-line treatments before considering knee replacement.
- Patient adherence and healthcare provider recommendations for these treatments are crucial for effective OA management.
- Understanding treatment uptake during the often lengthy wait for knee replacement is essential for optimizing patient care.
Purpose of the Study:
- To assess participation in guideline-based first-line treatments for knee osteoarthritis (OA) before and during the waitlist period for knee replacement.
- To identify factors associated with participation in these initial OA management strategies.
- To evaluate the extent to which patients on the waitlist were recommended guideline-based treatments.
Main Methods:
- A cross-sectional survey study was conducted with 136 patients on a waiting list for knee replacement due to knee OA at a Swedish public hospital.
- Participants completed self-reported questionnaires on demographics, physical activity, knee function, and treatments received before and during their waitlist period.
- Statistical analysis was used to investigate factors associated with treatment participation.
Main Results:
- Only 40% of patients received guideline-based OA management (Better management of patients with OsteoArthritis - BOA) and 53% received physiotherapy before being waitlisted.
- During the waitlist period, recommendations for BOA (10%), physiotherapy (30%), and weight management (15%) were low.
- Women participated in BOA and physiotherapy significantly more than men prior to referral.
Conclusions:
- Recommended OA treatment guidelines appear to be inadequately implemented within the Swedish healthcare system.
- There are disparities in care, with women participating more in recommended treatments than men.
- Further research into implementation barriers and healthcare equality for OA patients is warranted.
Objective:
To investigate to what extent individuals participated in guideline-based first-line treatments before being assigned to a wait list for knee replacement for osteoarthritis (OA), and to what extent they were recommended such treatments once on the list. Factors associated with participation in first-line management were also investigated.
Design:
All patients on the waiting list ≥ three months for knee replacement due to knee OA (n = 229) at a public hospital in Sweden were invited to participate in this cross-sectional survey study. 136 individuals (mean age 70 ± 9 years, 59% women) answered self-reported questionnaires including demographics, physical activity level, knee function and treatments before and during their time on the waiting list.
Results:
Before being referred to the waiting list, 40% had participated in guideline-based OA management (Better management of patients with OsteoArthritis (BOA)), 53% in physiotherapy, 67% in either BOA or physiotherapy whilst 23% of those overweight (BMI≥25) had received weight-management advice. Women had participated in BOA and physiotherapy twice as often as men (51% vs. 25%, p = 0.002 and 66% vs. 34%, p < 0.001) prior to waiting list referral. During their time on the waiting list, only 10% were recommended BOA, 30% physiotherapy and 15% weight-management. 38% of the patients that had never participated in BOA indicated that they were interested in participating while waiting for their knee replacement.
Conclusion:
Our results suggest that recommended treatment guidelines for OA may not be adequately implemented in Swedish health-care. Further exploration of implementation barriers and lack of equality of care appears warranted.
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