Patients’ Needs -- and Wants -- Don't Necessarily Influence Knee Treatment

Patients and physicians need to communicate more effectively about treatment management for knee pain, according to research to be presented at the American College of Rheumatology annual scientific meeting in San Diego.

Some 25 percent of adults in any community will suffer frequent knee pain which, as a chronic condition, can reduce activity and contribute to depression. While the keys to addressing this life-altering condition are exercise and education, it has remained unclear whether patients actually receive this course of management, despite their voiced preference for conservative treatment.

To document previous treatment patterns and personal preferences, 418 patients (294 of whom were female), average age 67 years, were studied. The majority, 343 (82 percent), had received non-steroidal anti- inflammatory drugs (NSAIDs) and analgesics such as aspirin and acetaminophen for knee pain management. Less than half (167 patients) had undergone physical therapy, and 36 patients (nine percent) had participated in no treatment for the condition. Overall patients reported a preference for more conservative, non-drug management including physical therapy and exercise. An amazing 40 percent (166 patients) stated either no preference or a lack of awareness about options and their effectiveness.

Included in the questions posed was whether patients would accept a total knee replacement (TKR) if offered. Only 25 patients (six percent) were already on a waiting list for TKR and, of those, four planned to decline the treatment if offered. Of those not on a waiting list, most would not accept the surgery despite its proven benefits. The reasons given varied from not being in enough pain to warrant such treatment to negative attitudes about surgery in general.

“Most physicians have been determining pain management procedures without consulting the patient about their preferences or educating them as to treatment options,” said Helene Mitchell of DeMontfort University in the United Kingdom, an investigator in the study funded by the Arthritis Research Campaign, a major medical research charity in the UK investigating arthritis in all its forms. “As a result, medication is prescribed far more frequently than physical therapy or exercise, which is at odds with patient preferences. By directing our attention to educating patients, addressing treatment beliefs and concerns, and bringing patient preferences into the decision process, we have a better chance of successful management of chronic knee pain.”

Source: American College of Rheumatology

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