Limited use of surgeon's advice on exercise for knee osteoarthritis

INTRODUCTION: The Good Life with osteoArthritis in Denmark (GLA:D) programme consists of patient education and supervised exercise therapy and adheres to clinical guidelines for knee osteoarthritis (OA). The purpose of this study was to present the treatment choice and clinical results of patients who were advised to participate in GLA:D before deciding on undergoing knee replacement. METHODS: Patient records from all patients with knee OA consulting one orthopaedic surgeon in 2015 were reviewed to identify those who were advised to seek GLA:D. Radiologic OA was classified with Kellgren-Lawrence (KL) grade 0-4: none-severe. Results after three months were extracted from the GLA:D database, including a visual analogue scale (VAS) for knee pain 0-100: best-poorest. RESULTS: Out of 142 patients with primary referrals due to knee OA, 83 (58.5%) were advised to participate in GLA:D. They had a mean age of 65.0 years (standard deviation (SD): ± 10.7), 59 (71.1%) were female, 34 (44.8%) had a KL grade 3-4 and were either not eligible for surgery or awaiting surgical decision. Only 18 (22%) participated in GLA:D, out of whom 14 (16.9%) had available three-month data. They improved (mean (SD)) from 61.4 (± 18.6) to 42.7 (± 25.1) (p < 0.001) with respect to VAS pain after three months. CONCLUSIONS: Few patients followed the surgeon's advice on GLA:D participation, indicating that treatment with GLA:D is underutilised. The pain reduction found in GLA:D participants confirms that patient education and supervised exercise therapy are beneficial prior to deciding on knee replacement, or if surgery is not indicated. FUNDING: none. TRIAL REGISTRATION: not relevant.