How might we change our approach to this growing condition to reduce suffering?
By Paul Bolger. Chartered Physiotherapist at Nano Physiotherapy, Kilkenny (www.nanophysio.ie).
If you have been keeping up with this series you will know that osteoarthritis is a growing problem, that many factors influence joint health and that our joints are very much living, breathing organs that deserve our attention.
Unfortunately, when it comes to joint health, our current management does not follow best practice guidelines.
We Have It Backwards
People who suffer from joint pain are usually treated with a combination of rest, medication and, occasionally, joint injections. A minority who are affected severely enough may have joint replacement surgery. Eventually, after surgery, they come face to face with a physiotherapist; start an exercise programme, learn about their condition and maybe lose weight if needed.
This approach is backwards. Truly valuable treatment should start where our current approach ends – with education, exercise and weight loss. How might we fix this?
An Effective Pathway
A standardised pathway for those suffering from joint pain would be an efficient use of resources that improves outcomes. How might this look?
A person with joint pain attends their GP. If their issue seems related to osteoarthritis, they are referred to a physiotherapist for further assessment.
Following assessment by a physiotherapist, they may be enrolled in a group programme that would run over a number of weeks. This programme would consist of strengthening exercises, education and, ideally, input from a dietician.
Programmes like this have been shown to improve outcomes in osteoarthritis – reducing pain, improving functional ability and improving people’s confidence in their ability to manage their condition.
Should people need further assistance they may be referred for specialised assessment. This way only those who truly need specialist review will get it – reducing unnecessary appointments, cutting waiting times and minimising invasive treatments like injections and surgeries. All the while it would improve outcomes for those suffering from the condition.
De-Medicalised Management
The above pathway would be a part of the healthcare system. What is probably more important than this is to target non-medical management of the condition. What do I mean by this?
I previously wrote about risk factors that put us at risk of suffering from osteoarthritis. By targeting these risk factors, we would cut the impact of the condition, lessening the need for medical management. Here are some ideas for what this would look like.
Promote Physical Activity:
Through active travel (facilitate safe walking, cycling, etc.); Facilitate exercise groups in the community for all age groups; Ensure access for all to desirable, safe outdoor spaces like parks and walkways.
Inform:
Ensure ALL members of society are informed about health.
Food:
Promote and facilitate healthy eating habits – e.g. regulate highly processed foods and advertising; promote and subsidise healthy ingredients.
Time & Space
It is hard to change habits for the better when people lead busy, stressful lives. I don’t know how best to approach this – but somehow allowing people to have the time and space to prioritise healthy changes is necessary.
Many other factors will have an impact here – like sleep quality, stress levels and community engagement.
The beauty here is that in promoting healthy behaviours that reduce osteoarthritis rates, we would be effectively improving health and cutting the impact of many other health conditions at the same time. This seems like a common sense investment in our society.
