A team-based care approach in primary care can alleviate the burden created by COVID-19 surgical backlog for Canadians suffering with hip and knee Osteoarthritis
References
Jonathan Wang, Saba Vahid, Maria Eberg, et al. Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study. CMAJ 2020;10.1503/cmaj.201521.
Canadian Institute for Health Information. Hip and Knee Replacements in Canada: CJRR Annual Statistics Summary, 2018-2019. Ottawa, On; CIHI; 2020.
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology / Arthritis Foundation Guideline for the management of osteoarthritis of the hand, hip, and knee. 2020;72(2):220–33.
Skou S, Roos E, Lauresen M, Rathleff M, Arendt-Nielsen L, Simonsen O, et al. A randomized controlled trial of total knee replacement. N Engl J Med. 2015;373:1597–606.
Davis A, Kennedy D, Wong R, Robarts S, Skou S, McGLasson R, et al. Cross-cultural adaptation and implementation of Good Life with osteoarthritis in Denmark (GLA:D): group education and exercise for hip and knee osteoarthritis is feasible in Canada. Osteoa
Wang et al provide a timely contribution highlighting the sizeable surgical backlog created by COVID-19. They estimate it will take 84 weeks in Ontario to clear this backlog with a significant investment of resources.1 We would like to add to this discussion about how best to optimize the health and quality of life for the thousands of individuals left in limbo while waiting for a rescheduled surgery.
Osteoarthritis (OA) is associated with $1.4 billion annually in direct health care costs.2 With more than 137,000 hip and knee total joint replacements (TJR) performed annually,2 this group makes up a sizable component of the COVID-19 surgical backlog. We propose that primary care clinicians, including physicians and physiotherapists, can work together to reduce pain and improve the quality of life for those with OA waiting for TJR.
International best practice guidelines for hip and knee OA strongly recommend patient education, exercise therapy, and weight control (if necessary) as essential treatments.3 Even individuals with severe OA have potential to improve their quality of life with comprehensive non-surgical management.4 Unfortunately, only half of Canadians with OA receive this care. In a landmark study (MEDIC), patients with severe knee OA who were eligible for TJR were randomized to either 1) TJR followed by 12 weeks of non-surgical treatment or 2) only 12 weeks of non-surgical treatment, which was delivered by physiotherapists and dieticians and consisted of exercise, education, dietary advise, insoles and pain medication. While those who had TJR experienced greater improvements in pain and function, patients in the non-surgical treatment also had clinically significant improvements 12 months later and 75% postponed their TJR at least1 year.4
Physiotherapists, as experts in exercise prescription and chronic disease management, are key members of the health care team to work with physicians in OA management. Physiotherapists can deliver comprehensive evidence-based programs such as Good Life with osteoArthritis Denmark (GLA:D) that are available across Canada and have been proven to reduce pain, improve function and quality of life.5 The pandemic has highlighted the urgency for local strategies to support and fund programs that connect primary care OA patients to community-based physiotherapists to obtain quality non-surgical care. Despite strong evidence, physiotherapy for knee and hip OA is rarely funded and Canadians often must use extended health insurance or pay out of pocket for these services.
In the time it will take for TJR to be re-scheduled, evidence-based non-surgical care of hip and knee OA can reduce pain, improve function, and better the quality of life for Canadians. Developing collaborative relationships between primary care clinicians in the management of OA, will vastly improve the management of OA during the pandemic and lay stronger foundations for growing a culture of team-based primary care for the future.