Original paper
Conservative non-pharmacological treatment options are not frequently used in the management of hip osteoarthritis

https://doi.org/10.1016/j.jsams.2006.02.002Get rights and content

Summary

Osteoarthritis (OA) is the most frequent joint disorder in seniors. Systematic reviews suggest that conservative treatment is effective and preferred in mild-moderate cases. The objective of this study was to examine the proportion of patients receiving physiotherapy, exercise or walking aids, and to explore factors associated with their prescription. We conducted a retrospective survey of patients about to undergo total hip arthroplasty for hip osteoarthritis. Patients were asked about past prescriptions for cane use, physiotherapy and exercise. Of 161 patients (36.6% male, mean age 68.7 ± 10.1 years), 76% were prescribed a cane (adherence = 86.2%). The main reason for not using a cane was vanity. Of the 28.0% patients prescribed physiotherapy, 73.3% received exercises compared to only 2.6% of non-physiotherapy patients. Patients who were older or worked in manual labour were more likely to be prescribed a cane and less likely to be prescribed physiotherapy or exercises. Men were less likely than women to be prescribed all three, but only cane use was statistically significant across genders. In conclusion, physiotherapy and exercise are not commonly prescribed in patients with hip OA.

Introduction

Osteoarthritis (OA) affects approximately 10% of Canadians, and is the most frequent joint disorder in seniors.1 Symptoms vary widely and pain may range from mild to incapacitating. The associated economic costs due to the disease include housekeeping, attendant care and loss of wages.2 Although surgery is effective in severe cases of OA,3 systematic reviews suggest that conservative treatment is effective and preferred in mild-moderate cases.4, 5

Conservative treatment includes both pharmacological and non-pharmacological treatments. Although non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving pain and improving function,6, 7 there remain questions of safety, tolerability and cost.8 For these reasons, some have recommended that NSAIDs should only be used intermittently to overcome periods of exacerbation,7and only after consideration of side effects and counselling of the patient.9

With respect to non-pharmacological treatment, effective treatments are aimed at either decreasing the stress across the joint (e.g., walking aid,10 weight loss11, 12), or increasing the stress the joint can withstand (improving muscle function with exercises13, 14, 15). There is substantial evidence that exercise is beneficial in mild-moderate knee OA,4, 5 and several studies suggest it may be beneficial for hip OA, including three randomised controlled trials (RCTs) (combined analysis of patients with either knee and hip OA16, 17, 18), and one implementation study (patients with hip OA analysed separately19). However, there are no studies that examine how frequent these proven effective conservative treatments are currently being prescribed. Therefore, the objective of this study was to describe the frequency of prescribing physiotherapy, exercise therapy and cane prescription in patients over their entire history of OA, and factors associated with their prescription.

Section snippets

Methods and procedures

We conducted telephone interviews of patients with OA who were scheduled to undergo total hip arthroplasty (THA) from five hospitals in Quebec, Canada. Patients were identified from the offices of the collaborating orthopaedic surgeons at the time that the surgery was scheduled and invited to participate in this study. Subjects were asked about ever being prescribed physiotherapy, exercise or a cane. Therefore, the results are not limited to prescription in pre-surgical patients, nor would the

Results

Of the164 patients approached, all agreed to participate in the telephone interview. Three of the eligible candidates could not be contacted prior to their surgery, leaving 161 subjects. The majority (139/161) of the participants were from two of the five participating hospitals (73 from one and 66 from another).

Of the 161 participants, 59 (36.6%) were male. The mean age was 68.7 ± 10.1 years, with men being slightly older than females (69.4 ± 9.7 years versus 67.4 ± 10.7 years). There were 32

Discussion

Our results indicate that in patients with OA (1) walking aids are often prescribed but less often used, (2) only 28% of patients were prescribed physiotherapy, (3) exercise programs were prescribed in 75% of patients receiving physiotherapy and in only 2.5% of patients not receiving physiotherapy and (4) patients who were older and did manual labour were more often prescribed a cane and less often prescribed physiotherapy, whereas men are less often prescribed all three.

Our results were

Conclusion

In conclusion, patients with hip OA are not using walking aids as often as they are prescribed due to both vanity and inconvenience of use. Proven effective exercise programs are underutilised by physiotherapists and rarely prescribed by physicians themselves.

Practical implications

  • When recommending walking aids to patients with osteoarthritis, the clinician should discuss potential obstacles with the patient in order to determine possible solutions.

  • Physicians are not recommending physiotherapy or exercise to the majority of their patients and the reasons need to be explored in future research.

  • It is not currently known if differences in exercise prescription among different physiotherapists is based on patient-expressed preferences, therapist-preferences, general evidence

Acknowledgements

This study was funded by the Réseau provincial de recherche en adaptation-réadaptation (REPAR) of the Fonds de la Recherche en Santé du Québec.

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