Table Of ContentOsteoarthritis Health Professional Training Manual
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Osteoarthritis
Health Professional
Training Manual
Edited by
David J. Hunter
Professor of Medicine, The University of Sydney, Sydney, NSW, Australia; Rheumatologist at
Royal North Shore Hospital, Sydney, NSW, Australia
Jillian P. Eyles
Kolling Institute of Medical Research, Sydney Musculoskeletal Health, The University of Sydney,
Sydney, NSW, Australia
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Contents
Contributors ix Support network 20
Preface xi Attitudes and beliefs 21
Screening for red flags 21
Use of recognized person reported outcome
1. Introduction to OA, communication,
measures 21
and person-centered care
Goal setting 22
Nina Østera˚s and Samantha Bunzli Key elements of documentation 23
Summary 23
Introduction 1
Physical assessment 23
Section 1a: Etiopathogenesis and epidemiology
Introduction 23
of osteoarthritis 1
Preparing for and undertaking the physical
What is osteoarthritis? 1
assessment 23
How does osteoarthritis develop? 2
Content of the physical examination 24
How common is osteoarthritis? 2
Specific content for physical examination of
Impact and burden of osteoarthritis 3
the knee, hip, and wrist/hand 27
Section 1b: Communication skills that support
Summary 35
best evidence osteoarthritis care and Section
Clinical practice points 35
1c: person-centered care 4
Concluding remarks 35
What is best evidence osteoarthritis care? 4
References 36
What is person-centered care? 4
What are additional considerations in the
3. Diagnosis, risk factors for OA
uptake of best practice osteoarthritis care? 10
Concluding remarks 10 development and progression,
Key points 11 OA prevention, and recognizing
Multi-choice questions 11 comorbidities
References 11
Yuqing Zhang and Sita M.A. Bierma-Zeinstra
2. Module 2: history taking and physical Introduction 39
assessment OA incidence 39
Impact of OA 40
Philippa Nicolson, Leticia Deveza and Melanie
OA diagnosis 40
A. Holden
Clinical diagnosis 40
Brief introduction to the chapter 15 Early-stage OA 40
History taking 15 Use of additional diagnostics by imaging or
Introduction 15 laboratory tests 40
The importance of communication in eliciting Holistic approach 41
accurate information 15 Risk factors 41
A holistic approach to history taking 17 Age 41
Symptom assessment 18 Sex 41
Participation restrictions 18 Race/ethnicity 41
Previous medical history 18 Overweight/obesity 42
Comorbidities 19 Joint injury, habitual and occupational physi-
Psychological factors 20 cal activities 42
Sleep and fatigue 20 Nutritional factors 43
v
vi Contents
Bone mineral density 43 Self-management support strategies 62
Joint shape and alignment 43 Responding to emotions 64
Muscle strength 44 Need for a framework 64
Genetics 45 Behavior change: why should we use a
Risk factors for symptomatic OA 45 theoretical framework? 65
OA prevention 45 Common elements of behavior change theory 65
Primary prevention 45 A social cognitive framework: social cognitive
Preventing knee injury 46 theory 66
Interventions after knee injury 46 Promoting self-efficacy: the central element 66
Interventions for hip dysplasia 46 Feedback loops: relationship among past
Interventions for cam deformity or FAIS 46 behavior, self-efficacy, and performance 67
Secondary prevention 47 Case study 68
OA and comorbidities 47 Background information 68
References 48 Relationship building and assessment 68
Soliciting the main concern 68
4. Core components of best evidence Using a social cognitive framework e
OA care: management planning, intervention 69
education, supporting self- Follow-up and evaluation 70
management and behavior change References 70
Shannon L. Mihalko, Phillip Cox, 5. Physical activity, exercise, and
Sarah Kobayashi and Jillian P. Eyles therapeutic exercise
Introduction to core components of best
Rana S. Hinman and Kim L. Bennell
evidence OA care 55
Keycomponents of best evidence OA care 55 What is physical activity, sedentary behavior,
Brief summaryof evidence supporting core exercise, and therapeutic exercise? 73
components of best evidence OA care 56 Recommendations for physical activity in OA 74
Education and support for self-management 56 Consequences of physical inactivity and
Increasing physical activityand exercise 56 sedentary behavior in OA 75
Weight management 57 Types of exercises that are beneficial for
A comprehensive approach to osteoarthritis people with OA 77
management 57 Cardiovascular (aerobic) fitness 77
Utilizes a biopsychosocial approach and Resistance (strength) training 77
perspective 57 Flexibility (stretching) exercise 78
Interdisciplinary coordinated care 57 Neuromotor (neuromuscular) exercise 78
Keyelements: self-efficacy, goals, strengths and Mind-bodyexercise 78
available resources, and behavior change Counselling-based physical activity
techniques 58 promotion 79
Self-efficacy 58 Mechanisms of exercise benefits 79
Goal-driven 58 Safetyof physical activity and therapeutic
Considers individual strengths and available exercise 79
resources 59 Principles of exercise prescription and
Incorporates a range of behaviorchange progression for OA 81
techniques 60 Overcoming barriers to physical activityand
Approaches to monitoring treatment progress exercise participation 82
and adjusting management plans 60 Services and supports to facilitate engagement
Regular monitoring 60 in physical activity and exercise for people
Use validated psychosocial tools to aid in with OA 84
assessment and to support monitoring 61 Increasing adherence to home exercise 88
Regularly review plan and adjust 61 Activity pacing and behavioral graded activity
Purpose and importance of education and for people with OA 88
support for self-management 62 References 89
Contents vii
6. Module 6: core components of best Medial and lateral wedges or insoles 115
evidence OA care e weight control Footwear 116
Walking poles 116
Marius Henriksen and Zhaoli Dai
Gait retraining 116
AIMS 95 Electrical stimulation for pain management 116
A brief introduction to the chapter 95 Classic rehabilitation approaches 117
Effect of weight control in OA pain manage- Manual therapy 117
ment and OA disease progression 95 Taping 117
Overweight or obesity is a strong risk factor Assistive devices 117
for OA 96 Thermal modalities 118
Mechanisms of body weight contributing to Complementary alternative medicine 119
the development and progression of OA 96 Yoga and pilates 119
Benefits of weight loss in OA 96 Tai chi and acupuncture 119
Other benefits of weight loss 97 Psychosocial strategies 119
Diet and OA: Summaryof dietarycomponents Summary and concluding remarks 120
and their effects on the prevention and References 120
management of OA 98
8. Pharmacotherapy
Diet and weight loss 98
Antiinflammatory diets 98
Shirley P. Yu and Richard O. Day
Dietary components 98
Meal replacement and low caloric diets 99 Aims for module 125
Patient-centered weight control to manage OA 100 Role and rationale of pharmacotherapy in
How can we best support people with OA to OA management 125
lose body weight? 100 Oral medications 126
How to maintain weight loss? 101 Acetaminophen (paracetamol) 126
Safety considerations 101 Nonsteroidal antiinflammatory drugs (NSAIDs) 126
Barriers to implementing weight control in Opioids 131
persons with OA 102 Adjuvant analgesics 132
Overall factors for weight loss 102 Topical therapies 133
Patient level 103 Capsaicin 133
Clinician level 103 Topical NSAIDS 133
Lack of time (patients and clinicians) 104 Intraarticular therapies 133
Concluding remarks 104 Corticosteroids 133
Selected links to any helpful online resources 105 Hyaluronan products 134
Europe 105 Platelet-rich plasma 134
US 105 Stem cell therapy 134
Asia 105 Dextrose prolotherapy 135
Australia 105 Dietary supplements/nutraceutical products 135
Africa 105 Glucosamine sulfate 135
Case study 3: Katrina 105 Chondroitin 136
References 106 Fish oil/krill oil 136
Vitamin D 136
7. Module 7: adjunctive rehabilitative Vitamin K 136
interventions Avocado soybean unsaponfiables (ASU) 137
Collagen 137
Rebecca Moyer and Howard Hillstrom Methylsulfonylmethane (MSM) 137
Tumeric/curcumin 137
Introduction to adjunctive rehabilitative
Boswellia serrata 138
interventions 111
Pycnogenol 138
Biomechanical devices and strategies 112
Experimental therapies 138
Varus/valgus unloader braces 112
Concluding remarks 139
Patellofemoral bracing 114
References 142
Hip bracing 115
viii Contents
9. Surgery for osteoarthritis 10. The interprofessional team, service
delivery, and professional
Peter F.M. Choong and Michelle M. Dowsey
development
Indications for surgery 147
Jocelyn L. Bowden, Carin Pratt,
Surgical options for osteoarthritis 149
Sarah Kobayashi and Martin van der Esch
Procedures for hip osteoarthritis 149
Total hip replacement 149 Introduction 165
Pelvic osteotomy 150 Principles underpinning successful deliveryof
Procedures for knee osteoarthritis 150 care 166
Total knee replacement 150 Support for self-management of osteoarthritis 166
Unicompartmental knee Person-centered care 167
replacement 151 The Chronic Care Model 167
Patellofemoral replacement 152 Interprofessional and multidisciplinary care 168
High tibial osteotomy 153 Exploring health and nonhealth consider-
Risks of surgery 154 ations for delivering care 169
General 154 The healthcare team 170
Specific risks related to total joint Delivering and coordinating osteoarthritis
replacement 154 care 177
Preoperative preparation 154 Thinking beyond health caredintegrating
General fitness 154 care into everyday life 183
Comorbidities 154 Pathways of care and adapting them to suit
Infections 155 different settings 186
Anesthetic and postoperativepain Enhancing osteoarthritis care in lower-
relief 155 resourced settings 187
Postoperative course 155 Incorporating evidence-based care into your
In hospital e Early Recovery After Surgery clinical practice 187
(ERAS) 156 Using the evidence pyramid (levels of
First 6 weeks 156 evidence) in evidence-based care 189
First 12 months 156 Top tier evidence to guide decision-making 189
Measuring outcomes 157 Other reliable sources of information 190
Patient expectations and In closing. 190
satisfaction 157 References 191
Acknowledgments 157
References 158
Index 195
Contributors
Kim L. Bennell, Department of Physiotherapy, The Jillian P. Eyles, Kolling Institute of Medical Research,
University of Melbourne, Melbourne, VIC, Australia Sydney Musculoskeletal Health, The University of
Sydney, Sydney, NSW, Australia
Sita M.A. Bierma-Zeinstra, Department of General
Practice & Department of Orthopedics and Sports Marius Henriksen, The Parker Institute, Copenhagen
Medicine, Erasmus MC - University Medical Centre University, Hospital Bispebjerg, Frederiksberg, Den-
Rotterdam, The Netherlands mark; Department of Clinical Medicine, Faculty of
Health and Medical Sciences, Copenhagen University,
Jocelyn L. Bowden, The Kolling Institute, Sydney Mus-
Copenhagen, Denmark
culoskeletal Health, The University of Sydney and the
Northern Sydney Local Health District, Sydney, NSW, Howard Hillstrom, Leon Root, Motion Analysis Labora-
Australia tory, Hospital for Special Surgery, New York, NY,
United States
Samantha Bunzli, The University of Melbourne, Depart-
mentofSurgery,StVincent’sHospital,Parkville,VIC, Rana S. Hinman, Department of Physiotherapy, The
Australia University of Melbourne, Melbourne, VIC, Australia
PeterF.M.Choong,UniversityofMelbourne,Department MelanieA.Holden,SchoolofMedicine,KeeleUniversity,
ofSurgery,MelbourneMedicalSchool,Parkville,VIC, Keele, Staffordshire, United Kingdom
Australia
Sarah Kobayashi, The Kolling Institute, Sydney Muscu-
Phillip Cox, Department of Health and Exercise Science, loskeletal Health, The University of Sydney and the
Wake Forest University, Winston-Salem, NC, United Northern Sydney Local Health District, Sydney, NSW,
States Australia;InstituteofBoneandJointResearch,Kolling
Institute, The University of Sydney, Sydney, NSW,
Zhaoli Dai, Charles Perkins Centre, School of Pharmacy,
Australia
Faculty of Medicine and Health, The University of
Sydney, Camperdown, NSW, Australia; College of Shannon L. Mihalko, Department of Health and Exercise
Medicine and Public Health, Flinders Health and Science, Wake Forest University, Winston-Salem, NC,
Medical Research Institute, Flinders University, United States
Adelaide, SA, Australia
Rebecca Moyer, School of Physiotherapy, Dalhousie
RichardO.Day,ClinicalPharmacology&Toxicology,St University, Halifax, NS, Canada
Vincent’s Hospital, Sydney and St Vincent's Clinical Philippa Nicolson, Nuffield Department of Orthopaedics,
Campus, University of New South Wales, Sydney,
Rheumatology and Musculoskeletal Sciences, Univer-
Australia
sity of Oxford, Oxford, United Kingdom
Leticia Deveza, Rheumatology Department, Royal North
Carin Pratt, Department of Physiotherapy, Royal North
Shore Hospital and Institute of Bone and Joint
ShoreHospital,NorthernSydneyLocalHealthDistrict,
Research, Kolling Institute, University of Sydney,
Sydney, NSW, Australia
Sydney, New South Wales, Australia
NinaØsterås,NationalAdvisoryUnitonRehabilitationin
Michelle M. Dowsey, Department of Surgery, University
Rheumatology, Division of Rheumatology and
of Melbourne, St Vincent's Hospital Melbourne,
Research, Diakonhjemmet Hospital, Oslo, Norway
Melbourne, VIC, Australia
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