Knee Osteoarthritis: Orthopedists Prescribing More NSAIDS and Less Lifestyle Management for Pain Relief What are the main findings?

Response:Our study findings indicated that during knee OA visits to orthopedists, the rate of PT referral and lifestyle (exercise or weight management) recommendations declined between 2007 and 2015, while these rates remained steady but low during primary care visits during the same timeframe. In contrast, between 2007 and 2015, prescriptions to NSAIDs significantly increased in both primary care and orthopedic visits, while narcotics increased during orthopedic visits and showed a non-significant upward trend in primary care visits. The study found that physician treatment choices were associated with non-clinical factors such as visit type, practice location, type of provider seen and few patient demographics. One interesting association was lower likelihood of PT or lifestyle recommendation in rural clinics. should readers take away from your report?

Response:The major takeaway from this research study is that patients might not be receiving optimum care for knee osteoarthritis. Exercise-based interventions, including physical therapy are recommended as one of the first line interventions in various clinical practice guidelines, yet, they are still being prescribed at a very low rate. Physicians seem more focused on helping their patients manage their pain with medications, (both NSAIDs and narcotics). However, it is important to consider the long-term benefits of lifestyle interventions such as weight management, exercise and physical therapy for mitigating declines in physical health, and reducing dependence on medications. What recommendations do you have for future research as a result of this study?

ResponseMore research is needed to determine barriers to prescribing exercise or physical therapy. In the current study we found that factors such as type of provider, practice location and type of practice, and patient demographics influenced the choice of treatments provided.  While the observed increase in non-narcotic medication (NSAIDs) would be expected as part of standard treatment protocols, the rise in narcotic prescriptions warrants investigation.

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Samannaaz S. Khoja, Gustavo J. Almeida, Janet K. Freburger. Recommendation Rates for Physical Therapy, Lifestyle Counseling and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings. Cross‐sectional Analysis of the National Ambulatory Care Survey (2007‐2015). Arthritis Care & Research, 2019; DOI: 10.1002/acr.24064

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