On the path to improved osteoarthritis (OA) management, how good is today’s map?
During this year’s ARHP Distinguished Lecture: Moving Toward Better Osteoarthritis Management, Kelli D. Allen, PhD, with the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill and the Center for Health Services Research in Primary Care, Durham VA Medical Center, highlighted ways to improve the map and remove roadblocks.
For the most part, Dr. Allen said, current treatment recommendations are in agreement with each other and based on systematic reviews of research findings. But a lack of sufficient evidence for many treatments exists, and the guidelines remain silent on key issues such as sleep, social determinants, comorbidities, psychological factors, treatment costs, and access. The guidelines also would improve with more specificity and practicality.
“Our guidelines are really kind of framed as a yes/no/maybe sort of template,” she said. “That’s not bad, but they’re not the types of guidelines that offer clinicians and health systems the kinds of practical steps for how to consistently deliver osteoarthritis treatment.”
Getting everybody, from patients to healthcare systems, to follow the map has proved difficult. Dr. Allen cited studies that showed only 52 percent of patients reported that a healthcare provider recommended physical activity, for example, and that while 80 percent of OA patients are overweight or obese, only four out of 10 patients reported that a healthcare provider had provided recommendations for weight management.
Another study found that 90 percent of knee OA patients who had joint replacement surgery in the United States never received physical therapy in the five years prior to surgery.
“The general picture that I take away from this is that we have some gaps to fill, particularly when it comes to a whole range of non-surgical treatments for osteoarthritis,” Dr. Allen said.
Much work continues to take place nationally and internationally to revise the map and change course.
Dr. Allen discussed “clearing the roadblocks” using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model. It includes developing more evidence-based mobile health options, paying closer attention to vulnerable populations, delivering more effective treatments and greater “doses” of behavior interventions, and shared decision-making. She noted the challenge and importance of sustaining these efforts year after year.
The Osteoarthritis Action Alliance (OAAA), a national coalition of almost 100 organizations advancing the 2010 National Public Health Agenda for Osteoarthritis, also works to remove OA treatment barriers so patients have the ability to benefit from proven interventions. For more information, visit oaaction.unc.edu.