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Clinical Practitioneers NOT adhering to guidelines for Osteoarthritis treatment

February 12, 2011

Clinical Practitioners Not Adhering to Evidence-Based Guidelines for Osteoarthritis
HOBOKEN, NJ — January 4, 2011 — New research found clinicians who care for patients with osteoarthritis (OA) are likely not following standard care guidelines that are based on current medical evidence.

Researchers noted physicians were prescribing medications for pain and inflammation, or opting for surgical interventions rather than recommending weight loss plans or exercise programs to patients with OA. Details of the study are published in the January 2011 issue of Arthritis Care & Research.

David Hunter, MD, University of Sydney, Sydney, Australia, and colleagues reviewed how standard clinical practice diverges from evidence-based recommendations in the management of OA. “We present a potential roadmap for optimizing the quality of OA healthcare for those developing and enforcing policy decisions, and for clinicians on the frontlines of OA management to enact practice change,” he said.

Current clinical practice does not reflect recommendations based upon medical evidence. The authors report that therapeutic interventions are primarily aimed at reducing pain and improving joint function by using therapies that target symptoms, but do not facilitate improvement in joint structure or long-term betterment of the disease. Frequently, physicians do not recommend conservative non-pharmacologic management therapies which leads to unnecessary diagnostic imaging and inappropriate referrals to orthopedic surgeons.

Many individuals with OA are overweight or obese. The authors support medical evidence which recommend a conservative non-pharmacologic management for OA patients. “Weight management and exercise programs tend to be overlooked by clinicians,” said Dr. Hunter. “These conservative approaches are beneficial to patients who adhere to weight-loss and exercise programs.”

Researchers further suggest that surgery be resisted when symptoms can be well managed by other treatment methods. The typical indications for a surgical approach in treating OA are debilitating pain and major limitation of functions such as walking, working, or sleeping. However, prior studies have shown that up to 30% of some surgical procedures are inappropriate and recent recommendations suggest routine arthroscopy for knee OA management should be avoided — something not reflected in clinical practice.

The study team also noted an overuse of inappropriate diagnostic imaging instead of clinical diagnosis based on history and physical examination. Based on current guidelines imaging should be reserved for instances where a diagnosis is unclear and radiography could rule out other diseases that may produce similar symptoms. Research studies estimate there are 95 million high-tech scans done annually in the US of which 20% to 50% of these scans being unnecessary, as the results of the scans failed to help treat or diagnose the patient’s symptoms.

“Eliminating unproven procedures and reducing needless costs is necessary to improve the quality and lower the cost of healthcare in the US,” concluded Dr. Hunter. “The management of OA should focus on a patient-centered and provider integrated approach that improves quality and reduces cost by following evidence-based recommendations.”

SOURCE: Wiley-Blackwell
Blog Note: there are Natural remedies for alleviating the inflammation and pain associated with Arthritis- without the site effects of NSAIDS

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