Conservative Management of Knee Osteoarthritis

Knee osteoarthritis is a common debilitating disease with an estimated prevalence of 30% in individuals over 45 years. Management of knee osteoarthritis can be divided into conservative and surgical measures. Conservative management is the first treatment recommended to delay surgical intervention. Exercise therapy is part of the core treatment in conservative management and is associated with muscle strengthening and hypertrophy, weight management, and even disease-modifying effects. Patients tend to have a lack of awareness of both the benefits of conservative treatment and the overall impact of conservative management on their well-being. Local Problem: Although most patients with knee osteoarthritis would benefit from a formal exercise regimen, many do not participate in these recommendations. Patients commonly state they lack confidence in correctly understanding and performing the movements, do not have enough time to complete the exercises consistently, and report fear of increased pain and injury. In addition, clinicians also state a lack of time and ability to provide thorough education to patients on the management of knee osteoarthritis. Methods: This project evaluation sought to assess stakeholders' perceived barriers and strengths in the conservative management of patients with knee osteoarthritis at a local clinic and perform a program evaluation of current measures in place. First, stakeholders were identified and given a baseline questionnaire of open-ended and Likert-style questions to assess stakeholder perceptions. Results were compiled and compared with recent literature on the current recommendations to improve the participation of patients in the conservative management of knee osteoarthritis therapies and formulated into an outline summary. Stakeholders' responses to the outline summary were recorded and constructed into an Executive Summary, which describes the current strengths, weaknesses, and barriers and provides recommendations for future projects. Interventions: This program evaluation focused on assessing the program for managing knee osteoarthritis patients. This was accomplished by evaluating current measures and comparing them to literature recommendations. The priority was to identify and speak with stakeholders to assess their perception of gaps, strengths, or weaknesses through a baseline questionnaire and discussion and then create an outline summary of the perceptions for stakeholders to evaluate and provide feedback. Stakeholder responses to the summary were collected and then compiled into a final executive summary. Results: Results demonstrated an overall increased awareness of the importance of conservative measures in knee OA treatment. Upon initial discussion, all participants thought that a formal education and referral program would be helpful but were concerned about the complexity of adding another process into the clinic. Most stakeholders felt that patients appreciated education and physical therapy referral but were mixed on how well patients participated in physical therapy. Stakeholders reported that they still provided the referral regardless of perceived participation in physical therapy. Conclusion: In conclusion, this program evaluation project sought to understand stakeholders' perceived barriers and strengths in the conservative management of patients with knee osteoarthritis. This project helped to identify that a formal education program at this clinic would likely not be beneficial. Stakeholders felt that education is one of the most critical aspects of managing knee osteoarthritis. Still, they felt confident in their ability to manage patients and refer them for expert treatment with their on-site Sports Medicine and Orthopedic Providers. This program evaluation would best be continued by evaluating patients' perceptions of the strengths and barriers of the conservative management of their knee osteoarthritis. Clinicians could further identify patients' social determinants of health, such as income, health insurance, education, social support, and location, that could substantially impact their ability to engage in conservative therapies.