Knee Works
17 things that help a knee
- 1. The optimal management of OA of the hip and knee combines both nonpharmacologic and pharmacologic treatment modalities (Strength of Research, 96%, how confident are we that this helps).
- 2. The initial treatment of OA should focus on patient empowerment and self-driven therapies. All patients should receive education on lifestyle changes, exercise, pacing of activities, and weight reduction (SOR, 97%).
- 3. Monthly telephone contact, even by lay personnel, can improve the clinical status of patients with OA (SOR, 66%).
- 4. A physical therapy consultation focusing on appropriate exercises may benefit patients with OA, although this recommendation is largely based on expert opinion. The physical therapy visit may also include advice regarding assistive devices for ambulation (SOR, 89%).
- 5. Weight loss is encouraged and can relieve pain and stiffness and improve function (SOR, 96%).
- 6. Assistive devices for ambulation can reduce pain associated with OA. A Cane or crutches
- 7. Among people with knee OA and mild or moderate knee instability, a knee brace can reduce pain, improve stability, and reduce the risk of falling (SOR, 76%).
- 8. Insoles can also reduce pain among people with knee OA (SOR, 77%).
- 9. Thermal modalities (heat0 may improve knee OA, but there is less evidence that ice may be effective (SOR, 64%).
- 10. Transcutaneous electrical nerve stimulation (TENS) can help with short-term pain control among patients with hip or knee OA (SOR, 58%).
- 11. Acupuncture can relieve symptoms of knee OA (SOR, 59%).
- 12. Acetaminophen is the first choice for pharmacologic treatment of OA. Doses up to 4 g/day may be initiated before the use of other medications (SOR, 92%).
- 13. NSAIDs may be used at their lowest effective dose, and long-term use should be avoided if possible. Among patients at an increased risk for gastrointestinal tract bleeding, clinicians should prescribe either a COX-2 selective agent or a nonselective NSAID with co-prescription of a proton pump inhibitor or misoprostol. NSAIDs should be used with caution among patients with cardiovascular risk factors (SOR, 93%).
- 14. Topical NSAIDs and capsaicin can be effective as monotherapy or adjunctive treatment for OA of the knee (SOR, 85%).
- 15. People with moderate to severe pain associated with knee OA that is not responding to oral therapy can be treated with intra-articular injections (cortisone) (SOR, 78%).
- 16. Intra-articular injections of hyaluronate are associated with delayed onset of analgesia but a prolonged duration of action vs injections of corticosteroids (SOR, 64%).
- 17. Treatment with glucosamine and chondroitin may relieve symptoms of OA, but treatment should be discontinued if there is no relief after 6 months of therapy (SOR, 63%).
By Rich Waldron on Oct 13, 2009
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