Effective Management of Knee Osteoarthritis
By: Jayson Hull SPT, CSCS
Overview
While contemplating capstone topics I knew I wanted to present on a topic related to exercise. However, I was torn between something more sports related such as ACL prevention or something more functional for the general population. During my outpatient rotation I treated many patients with knee Osteoarthritis (OA), and the majority of them were unaware of the effectiveness of treatments, particularity exercise. Patients generally had a mindset that physical therapy was just something their doctor told them they had to do before an inevitable knee replacement. Additionally, if a patient received some type intra-articular injection during the course of PT treatment they felt as if they were “healed”. I wanted to educate patients, and those at risk for knee OA on the efficacy of treatments and benefits of exercise.
Interesting facts:
- 70% of people over 70 have knee OA evident by x-ray
- Obese women are 4-5x more likely to have knee OA
- Knee OA is one of the top 5 leading causes of disability among adults
- 40% of adults with knee OA report their health to be “poor” or “fair”
Purpose
Based on my outpatient experiences and the high prevalence of knee OA, I developed an educational module and handout explaining the common treatments used to address knee OA symptoms. The module also explains how exercise can improve function and decreasing pain. Presenting this information in an easy to understand manner to older individuals may empower them to start, and continue a regular exercise program to maintain or increase their independence.
Products
- I created a PowerPoint presentation designed specifically for older adults. This presentation was designed to synthesize current evidence on the common procedures used in treating the symptoms of knee OA, as well as the effectiveness of exercise. In the presentation I focused on the efficacy of intra articular injections, orthoscopic debridement, total knee replacements, and exercise. Knee OA Presentation
- The educational pamphlet I created provides a simple summary of knee OA. It also includes three types of injections, their purpose and the length of their effectiveness. Further, the handout discusses the importance of exercise and general recommendations when exercising with knee osteoarthritis. Knee OA Handout
Evaluation
In order to evaluate the overall effectiveness of my presentation and educational brochure, I created a brief survey for the members of the audience. Capstone assessment
Reflection
I found making the PowerPoint and handout enjoyable and less stressful than I anticipated. I ran into trouble at one point deciding how to present the information on exercise. Originally, I wanted to demonstrate and provide different exercises and exercise modifications to help strengthen the lower extremity and improve knee OA symptoms. I quickly realized through a conversation with Mike Gross and the literature that I wouldn’t be unable to make specific exercise recommendations for a diseased population. Knee OA has many different origins and presentations. Therefore a generalized exercise program would be inappropriate. I ended up sticking with three recommendations that can be applied to all, those being; improving lower extremity strength, increasing physical activity and managing BMI. I stated the importance of consulting a physical therapist for an individual evaluation and specific exercise recommendations.
I received good feedback from the audience on my presentation, which I presented twice at Carol Woods retirement community. I interacted with many of the individuals in attendance after the presentation answering more questions. All of them thanked me for coming, stating the information was helpful and educational. According to the written feedback from the audience the flow, clear key points, and answering of questions were my strongest points. Next time I will speak louder and possibly a little slower when presenting to an older audience, as this was a consistent comment. Overall, I feel the presentation was a success, and I enjoyed my experience.
Acknowledgments
I’d like to thank Carol Giuliani, who helped me identify an audience that could benefit from my presentation, as well as put me in contact with members of the community who work with older adults. Carol also provided constructive feedback for my presentation and educational handout. I would also like to recognize Erin Crawford the fitness facilitator at Carol Woods retirement community for her support, and effort in helping arrange an audience. Finally, I want to thank Prue Plummer for serving as my Capstone advisor.
Relevant Research
Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011 Jan;14(1):4-9.
Centers for Disease Control and Prevention. (2014, Dec 4). Physical Activity for Arthritis Fact Sheet. Retrieved Jan 10, 2015, from Arthritis: http://www.cdc.gov/arthritis/pa_factsheet.htm
Dieppe P, Basler HD, Chard J, Croft P, Dixon J, et al. Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology (Oxford). 1999 Jan;38(1):73-83.
Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA. Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. J Physiother. 2011;57(1):11-20.
Juhl C, Christensen R, Roos EM, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014 Mar;66(3):622-36.
Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ. 2014 Oct 7;186(14):1057-64.
Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, et al. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. 2013 Dec;29(12):2037-48.
Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 2008 Jan 23.
Minns Lowe CJ, Barker KL, Dewey M, Sackley CM. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials.
Núñez M, Lozano L, Núñez E, Segur JM, Sastre S, et al. Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Arthritis Rheum. 2009 Aug 15;61(8):1062-9.
Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, et al. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord. 2015;8:1-8.
Roddy E, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis. 2005 Apr;64(4):544-8.
Trigkilidas D, Anand A. The effectiveness of hyaluronic acid intra-articular injections in managing osteoarthritic knee pain. Ann R Coll Surg Engl. 2013 Nov;95(8):545-51.
van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, et al. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil. 2014 Oct;95(10):1962-8.
van der Weegen W, Wullems JA, Bos E, Noten H, van Drumpt RA. No Difference Between Intra-Articular Injection of Hyaluronic Acid and Placebo for Mild to Moderate Knee Osteoarthritis: A Randomized, Controlled, Double-Blind Trial. J Arthroplasty. 2014 Dec 13.
Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N. Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br. 2003 Jan;85(1):52-6
5 Responses to “Effective Management of Knee Osteoarthritis”
Prue Plummer
Jayson,
You did a great job synthesizing this information into a great presentation! I hope you’ll continue to educate and motivate patients and your professional peers in the future.
Congratulations!
Prue
Carol Giulani
Jayson
Great job getting this information condensed and relevant for the older adult population. You are right on that so many older adults with OA do not know or believe the value of exercises. I guess that education is on us. Your power point presentation and handout should help clarify the range of possibilities for clients. NOT exercise is the problem and I think you made that point quite well.
Cara Hehn
Hi Jayson,
First, awesome job! I have to say all of your pictures were excellent, and really contributed to the learning! Even with a topic I was familiar with, you covered OA so extensively that I felt like I learned a lot. First, I was shocked at the fact that 5lbs of weight loss leads to 20 lbs. reduction of force at the knee joint! That is really incredible, and speaks volumes for the need for education and weight loss management. I thought it was really great how you included the types of pain and separated them into “good” and “bad” because a lot of first time exercise may get confused and think that because they are sore they may be hurting themselves and should stop exercising. It was good that you cleared that up! From a clinical perspective, I really enjoyed how you detailed the treatment options, specifically the types of injections. I was unaware of Platelet-Rich Plasma injections, which are interesting to me in the fact that they last up to 6 months. I was also glad to see your inclusion of cortisone shots and the possible “con” that goes along with them, in that soft tissue damage may result. My father had a bad fall off a bike this past summer and a resulting rotator cuff tear. The physician offered him the option of cortisone shots, which I told him that if at all possible, he should try not to take due to the possibility of soft tissue damage with continued use. It was surprising to me that my sister, who is a nurse, had never heard of this before. My father did end up getting a few shots, and was not completely compliant with his HEP of AROM, and ended up with a bone spur, despite my incessant nagging. I think your overview of treatment options was very clear and pointed out all of the benefits and risks, which is important in making a patient feel informed and in control of their outcomes. Thanks for sharing! Also, I loved the brochure, pretty and to the point!
~Cara
Mark Boles
Jayson,
I think this is an excellent topic and target audience for a capstone project. As we have learned over the course of our physical therapy education, the geriatric population continues to increase at a tremendous rate. With this increase in the number of geriatric individuals one can predict that the number of people with OA will also increase. It is inevitable that something must be done to curb the potential amount of spending that will be exhausted on medical treatment for this population. Your presentation does a great job providing information on the benefits of exercise for those with, or at risk of knee OA. In the coming years I think physical therapists will play a pivotal role in this shift towards conservative and more affordable treatment/preventative options for these individuals. I also really liked the pamphlet you made and think this is an excellent way to start spreading the word about OA and the potential benefits of conservative management. I actually have a few family friends who may benefit from this pamphlet. I have briefly discussed with them the benefits of conservative treatment but I think giving them a physical, professional looking pamphlet like this could be more impacting. If it’s okay with you, I would love to share this information. Great job, Jayson.
Mark
Jonathan Samuelson
Hi Jayson-
I really liked the content of the power point. You broke things down, do that they are easy to understand. That’s important when you are talking to an audience that does not have a background in exercise or physical therapy. The diagrams and x-ray were real helpful showing the anatomy and pathology of the knee. The picture of the total knee replacement will also be helpful to the audience. Breaking down each of the injection treatments, so that there was one per page made it real easy to understand. I also liked the circular flow chart that you added, so that people have a visual of the harmful cycle that can accompany OA. The slide on the goals of exercise that featured the bubbles was equally helpful.
As far as the handout, you were successful in condensing the main points of your power point presentation along with some good pictures. I realize how hard it is to fit all the information you want onto a brochure template. Sometimes it makes sense to play with the font to see what fits on the template and what is most clear. Some fonts are easier to read than other fonts. If you are dealing with an older audience vision is sometimes an issue, so the clearer the better.
Jonathan