Information de reference pour ce titreAccession Number: | 00126062-200711000-00013.
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Author: | Porcheret, M.; Jordan, K.; Jinks, C.; P. Croft in collaboration with the Primary Care Rheumatology Society
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Institution: | Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Keele, Staffs ST5 5BG, UK
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Title: | |
Source: | Rheumatology. 46(11):1694-1700, November 2007.
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Abstract: | Objectives: To describe the treatment of knee pain in older adults in primary care and to compare reported practice with published evidence.
Methods: A semi-structured interview of older adults with knee pain about their use of 26 interventions for knee pain.
Results: 201 adults were interviewed. A median of six interventions had been advised for each participant, with heat and ice (84%) the most frequently advised, followed by paracetamol (71%), compound opioid analgesics (59%) and non-selective non-steroidal anti-inflammatory drugs (59%). Three core treatments for knee pain (written information, exercise and weight loss) were advised to 16%, 46% and 39% of the participants, respectively. Half of the interventions had been initiated through 'self care'. Most core treatments had not been initiated before second-line interventions had been used, paracetamol being the exception. Referral to surgery was commonly initiated before more conservative options had been tried.
Conclusions: Interventions recommended as core treatment for knee pain in older adults were underused-in particular, exercise, weight loss and the provision of written information. There appeared to be early reliance on pharmacological treatments with underuse of non-pharmacological interventions in early treatment choices. Self care played an important role in the management of this condition. The study provides clear evidence on the need to improve the delivery of core treatments for osteoarthritis and highlights the need to support and encourage self care.
(C) British Society for Rheumatology 2007. Published by Oxford University Press. All rights reserved.
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Author Keywords: | Knee pain; Knee osteoarthritis; Treatment; Primary care; Older adults.
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References: | 1 Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis (2001) 60:91-7.
2 Wilkie R, Peat G, Thomas E, Croft P. The contribution of peripheral joint pain to participation restriction in community-dwelling adults aged 50 years and over. Arthritis Rheum (2004) 50(Suppl):665).
3 McAlindon TE. The Knee. Bailliere's Clin Rheum (1999) 13:329-44.
4 Peters TJ, Saunders C, Dieppe P, Donovan J. Factors associated with change in pain and disability over time: a community based prospective observational study of hip and knee osteoarthritis. Br J Gen Pract (2005) 55:205-11.
5 Jinks C, Jordan K, Ong BN, Croft P. A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. Rheumatology (2004) 43:55-61.
6 Saunders C, Donovan JL, Dieppe PA. Unmet need for joint replacement: a qualitative investigation of barriers to treatment among individuals with sever pain and disability of the hip and knee. Rheumatology (2004) 43:353-7.
7 Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med (2000) 133:635-46.
8 World Health Organisation Scientific Group. The Burden of Musculoskeletal Conditions at the Start of the New Millennium. In: Technical Report Series 919. (2003) Geneva: World Health Organization.
9 Quality and Outcomes Framework Guidance 2006. (2006) Accessed 15 March 2007. British Medical Association. Available at: http://www.bma.org.uk/ap.nsf/Att...- ouverture dans une nouvelle fenêtre$FILE/Quality+and+outcomes+framework+guidance+-+Feb+2006.pdf.
10 The Musculoskeletal Services Framework. (2007) Accessed 15 March 2007. Department of Health. Available at: http://www.18weeks.nhs.uk/cms/Ar...- ouverture dans une nouvelle fenêtre.
11 Standards of Care for people with Osteoarthritis. (2007) Accessed 15 March 2007. Arthritis and Musculoskeletal Alliance. Available at: http://www.arma.uk.net/pdfs/oa06...- ouverture dans une nouvelle fenêtre.
12 Osteoarthritis: the care and management of adults with osteoarthritis. (2007) Accessed 15 March 2007. National Institute for Health and Clinical Excellence. Available at: http://guidance.nice.org.uk/page...- ouverture dans une nouvelle fenêtre.
13 Porcheret M, Jordan K, Croft P. in collaboration with the Primary Care Rheumatology Society. Treatment of knee pain in older adults in primary care: development of an evidence-based model of care. Rheumatology (2007) 46:638-48.
14 Jordan KM, Sawyer S, Coakley P, Smith HE, Cooper C, Arden NK. The use of conventional and complementary treatments for knee osteoarthritis in the community. Rheumatology (2004) 43:381-4.
15 Linsell L, Dawson J, Zondervan K, et al. Prospective study of elderly people comparing treatments following first primary care consultation for a symptomatic hip or knee. Fam Pract (2005) 22:118-25.
16 Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis (2003) 62:1145-55.
17 Altman RD, Hochberg MC, Moskowitz RW, Schnitzer TJ. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum (2000) 43:1905-15.
18 Ericsson KA, Simon HA. Protocol analysis: verbal reports as data (1984) Cambridge, MA, USA: The MIT Press.
19 Bellamy N. WOMAC Osteoarthritis Index. In: A users guide (1996) London (Ont.): London Health Services Centre: McMaster University.
20 Walker-Bone K, Javaid K, Arden N, Cooper C. Regular review: medical management of osteoarthritis. Br Med J (2000) 321:936-40.
21 Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med (1999) 107:542-8.
22 Anderson RE, Crespo CJ, Bartlett SJ, Bathon JM, Fontaine KR. Relationship between body weight gain and significant knee pain in older Americans. Obes Res (2003) 11:1159-62.
23 Haslam D, Sattar N, Lean M. Obesity - time to wake up. Br Med J (2006) 333:640-2.
24 Mehrotra C, Naimi T, Serdula M, Bolen J, Pearson K. Arthritis, body mass index, and professional advice to loose weight. Implications for clinical medicine and public health. Am J Prev Med (2000) 27:16-21.
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Language: | English.
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Document Type: | CLINICAL.
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Journal Subset: | Clinical Medicine.
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ISSN: | 1462-0324
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NLM Journal Code: | 100883501, ddb
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