A review of strategies currently used to self-manage knee osteoarthritis in the aging population

Purpose

To determine the current strategies used for the self-management of knee osteoarthritis in the over 65s. Current recommendations include the general population however dismiss the changes in pain mechanisms in the older adult. 

Approach

Methodology
Literature review
Research question
What physiotherapy self-management strategies are used for knee osteoarthritis in the over 65s?
In order to define the research question the PICO model was implemented as below.
P: patient/population – over 65s with knee osteoarthritis
I: Intervention – self-management
C: Comparison – usual care
O: outcome – improvement in condition management

Database searches were performed using AMED, CINAHL, EMBASE and Web of Science.
A set search was completed and then combined using Boolean operators were used to combine searches. Truncation, MeSH, adjacency and subject headings were also used.
Criteria
The search was limited to the past 5 years in order to use the most up to date evidence. Other inclusion criteria included the ability to access full text through the University of Edinburgh or OpenAthens. Articles were to be written in, or available in English. The population was to be over 65 and have a diagnosis of Knee Osteoarthritis. Articles discussing Knee osteoarthritis in conjunction with other joints were excluded. All methodology was included.
The process of elimination was made by firstly reading the title, followed by the abstract and then the article.

Outcomes

Results: The articles within this review all recommend exercise for the management of KOA in the over 65s.  Out of the 6 articles, 2 completed home-based exercise, 3 completed group-based exercise and 1 supported exercise but did not disclose best application. The exercise intervention varied in type from yoga, cycling, water-based, land-based, individual home exercise programs to self-management programmes. All studies demonstrated improvements that confirms exercise is an appropriate ongoing recommendation for the management of knee osteoarthritis in the elderly population.
This review highlights the benefits of a range of exercise applications that are safe for the elderly population to consider as long term treatment. What has not been determined from this review, is the most appropriate form of exercise or delivery for the elderly population.

Conclusion(s): Self-management strategies used for knee osteoarthritis in the elderly mainly include exercise. Themes of application include home-based, home and community, community and hospital and home-based self-care. From reviewing the literature, varied forms of exercise are completed but all demonstrate some improvement. Supervised exercise and group-based exercise appear to be a popular application.
Support for patients is required as the first line of treatment to educate and advise on the appropriate pathways for self-management. Adopting a shared decision-making approach to offer treatment pathways with the best available evidence for patients to make an informed decision.
This review highlights the need for further research into the self-care or self-management strategies completed for the long-term management of knee osteoarthritis in the elderly. Literature and guidelines heavily promote exercise and activity however it is not clear which is most beneficial.

Cost and savings

Nil cost

Implications

This review could influence change in recommendations for the management of knee osteoarthritis in the elderly. Leading care in the community. 

Top three learning points

N/A

Funding acknowledgements

This work was not funded, it was part of a submission for the University of Edinburgh.