Osteoarthritis Quality Standards

The National Institute for Health and Care Excellence (NICE) has released new quality standards for the diagnosis and treatment of osteoarthritis. The standards have been drawn up after consultation and are supported by bodies including The Primary Care Rheumatology Society and the British Association of Prosthetists and Orthotists.

Osteoarthritis affects some seven million people in the UK and can be a life-limiting condition. Although its prevalence increases with age, osteoarthritis can be caused by a mix of genetic, environmental and lifestyle factors. This new quality standard covers the management of the condition from initial diagnosis and assessment through to ongoing management and support including the consideration of remedial joint surgery.

In recognition of the fact that extensive investigations, including x-rays and MRI scans, add little to the treatment plan, NICE recommends that a more practical and simple test should be enough to deliver an initial diagnosis. The standards therefore recommend that a simple test of having activity-related joint pain and any morning joint stiffness lasting no longer than 30 minutes should suffice.

As osteoarthritis is a condition which generally develops over time, the quality standard recommends the use of a self-managed plan wherever possible. This will include a multi-level approach including pain control, a weight management plan if required together with an exercise plan. This last should include a mix of muscle strengthening and aerobic exercise.

Although the plan is primarily written for the benefit of patients and the NHS; it is likely that physiotherapists, osteopaths and other health professionals may be called upon to help with treatment plans. Commenting on the Chartered Society of Physiotherapy website, Professor Krysia Dziedzic who helped to develop the standards said “We know that patients want access to non-pharmacological therapies and physios should be leading the way in the delivery of these.”

As people increasingly look for blended solutions, which include ongoing non-pharmaceutical management of conditions, the demand for physiotherapists and other health professionals can only grow; even if the incidence of osteoarthritis were to remain unchanged. However an Arthritis Research UK project has predicted that between 2010 and 2020 the number of people with osteoarthritis of the knee will increase from 4.7 to 6.5 million. It is little wonder therefore that NICE comments that the majority of hip and knee replacements in the UK are due to osteoarthritis and that currently treatment varies across the country.

This places an increasing demand on physiotherapists and others, both in the ongoing management of conditions and in assisting patients to recover from joint replacement surgery.  Whilst some of the burden may be taken up by new entrants to the profession, the challenge is still to find ways of working which will maximise treatment time.

Quoting a cliché, that means learning to work smarter not harder; taking full advantage of technological solutions in order to reduce time spent on the non-treatment elements of patient management.  These solutions include opening up the diary to enable patients to directly book online appointments, the electronic filing of patient records or taking card payment details at the time of booking. To borrow from the NICE standard, the more the health profession can take practical and simple measures to reduce the administrative burden, the more time can be spent on helping patients to manage their condition and get on with their lives.