A recently published editorial in the British Journal of Sports Medicine, which was written by lead author JP Caneiro and an international team of leaders in the field of osteoarthritis, calls for three actions to improve the way that we think and talk about knee osteoarthritis
Patients with knee osteoarthritis suffer from pain and physical limitations. Many of these patients believe that their symptoms are solely caused by structural damage to their knee joint. Viewed through this lens, it makes sense that many patients believe that a surgical “fix” is the only way that they will achieve relief from their pain and limited function. However, viewing knee osteoarthritis through this structural lens only allows us to see one part of a broader picture. As this editorial points out, knee osteoarthritis is a “whole person condition” with symptoms that are also influenced by social, psychological, and behavioural factors. When viewed through this lens it becomes clear that the symptoms of knee osteoarthritis can be alleviated without relying primarily on surgical “fix”. To help clinicians change the lens through which patients view their knee osteoarthritis, the authors of the editorial recommend three actions
Change the message:
Clinicians should take care when explaining knee pain to patients. They should make it clear to patients that knee osteoarthritis is influenced by a wide array of factors that contribute to sensitized knee structures. The experience of pain is not only caused by damage to the knee joint. When patients are already closely wedded to viewing their knee pain through a structural lens, clinicians are encouraged to challenge these beliefs by exploring the patients own lived experiences.
Change the treatment focus:
Clinicians must ensure that their treatment recommendations are not influenced by their own view of knee osteoarthritis as a primarily structural problem. They should not view surgery such as total joint replacement as inevitable for all patients with severe osteoarthritis. Pain and disability can also be reduced through non-surgical treatments (e.g. weight loss, targeted exercise, and early education) which target multiple factors that influence a person’s experience of pain. Clinicians should recommend appropriate non-surgical treatments to patients prior to referring them for surgery
Put the patient in charge:
Clinicians should put patients in charge of their care. This can be achieved by (among other things): encouraging patients to have a positive mindset towards managing their knee pain over the long term, promoting weight loss for overweight patients, supporting patients to lead a healthier lifestyle, and ensuring that any decisions about the risks and benefits of surgery are shared between the patient and clinician.
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