Real-world clinical result from a multimodal management program for knee osteoarthritis

Abstract

Purpose: Most current clinical management of knee osteoarthritis (OA) mainly focuses on pain management. However, clinical studies have demonstrated the merits of addressing the multifactorial causes involved in the development of OA. As they should be, these studies are regulated by strict research criteria, which might not reflect the clinical reality. The goal of this study is to present a real-world experience of a holistic knee OA management program aiming at personalizing treatment plans based on the patients' clinical characteristics and the presence of biomechanical markers linked with OA. Method(s): A consecutive series of 102 knee OA patient enrolled in the I manage my osteoarthritis program (mykneeosteoarthritis.ca) were selected at the 10 month reassessment visit. This program emphasis on patient education, physical activities, healthy weight management and addressing biomechanical markers known to be linked with knee OA. After taking into account patient history, a musculoskeletal assessment, a 3D knee kinematic assessment (KneeKG) and patient reported questionnaires, a multidisciplinary team develop a personalized care management program based on evidence-based clinical guidelines (OARSI, ACR, etc.). Two follow up sessions were offered to patients to adjust care management program and to provide support. Subjective questionnaires, medication intake, OA biomechanical markers and weight were compared pre- and post- management program. Result(s): 63 women and 39 men (mean age of 59 years old, BMI of 27.4) were included in the analysis. All KOOS scores (pain, quality of life, symptoms, function daily living and Sport/Rec. function) and pain catastrophizing scales significantly improved (p < 0.01 for all scales) at the follow up with improvements superior to the minimal clinically important difference. The percentage of patients using analgesic (28%) and nonstreroidal antiinflammatory drugs (NSAID) (38%) did not significantly decrease compared to the 6 months period prior to their enrolment. However from these medicated patients, the ratio of patients reporting regular intake of analgesics (>=3 times/day) went from 76% to 45% and went from 66% to 38% for regular intake of NSAID (>=2 times/day).74% and 93% of patients showed improvements in at least one biomechanical markers link to OA for the medial compartment and the patellofemoral compartment respectively. We also registered improvements in physical therapy strength and flexibility tests, but failed to show a significant group weight loss. Interestingly 7 out of 11 patients initially scheduled for a knee arthroplasty postponed their surgery, due to improvements. Conclusion(s): Results show that patients enrolled in the I manage my osteoarthritis program not only improve their quality of life but corrected different modifiable factors linked to the progression of knee OA. A clustered randomised clinical trial including 2000 patient is currently taking place to demonstrate the clinical economical value of this multimodal program.