Education, adherence and physical activity: three main markers of recommendations
Patient education allows them to understand their pathology and therapeutic options. Then the patient’s adherence to their care pathway optimizes the effectiveness of the interventions. Finally, appropriate physical activity helps improve joint function and quality of life.
The study, published in annals of physical and rehabilitation medicine in October, develops these recommendations using expert committees, made up of researchers and doctors from various disciplines, responsible for analyzing a wide range of scientific studies.
The recommendations were established based on levels of evidence, an assessment of the strength of the recommendations (from A to D) and an average level of agreement between experts rated out of 10 (with the standard deviation), favoring a consensual approach.
Following these five major recommendations, the study also evaluates several interventions identified as beneficial. This is the case for land-based or aquatic physical exercise programs targeting the lower limbs. The use of a cane may also be offered to relieve pain and improve walking ability, while weight loss, particularly in overweight or obese people, is essential to reduce pressure on joints. Spa treatments, when they integrate education and physical activity, as well as acupuncture for its non-specific analgesic effects, can also be considered.
Conversely, certain practices, such as kinesiotaping (self-adhesive tapes), simple knee braces, electrotherapy, thermotherapy, extracorporeal shock wave, laser or electromagnetic therapies, are not recommended due to their low demonstrated effectiveness. in this indication.
The importance of interpersonal connection and physical activity
Adherence to physical exercise therapy decreases after 3 months, hence the importance of regular support, whether physical, telephone or written. An increase of 1,000 steps/day is associated with a 16% to 18% reduction in the risk of developing functional limitations over two years according to one study. The minimum objective is 3,000 steps/day with an optimal of 6,000 steps/day.
Recommendations for adapted physical activity (APA) include endurance and muscle strengthening exercises, carried out in a progressive and safe manner. Aquatic activities such as aquagym or swimming, and gentle land-based exercises such as Nordic walking or yoga, are strongly recommended to improve joint mobility and reduce pain.
Specific practices such as tai chi or baduanjin (a form of slow Chinese gymnastics), are also recommended for their positive impact on balance and coordination. The main goal is to maintain regular activity, adapted to individual abilities and needs, while minimizing stress on the affected joints.
Cognitive-behavioral therapies: a secondary role
Specific cognitive-behavioral therapies (CBT) demonstrate benefits in the management of chronic pain. However, the steering committee highlights the lack of trained professionals and clarity on the required practice qualifications. In addition, studies show that CBT is more effective when combined with other interventions, such as physical activity.
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Knee osteoarthritis involves a diversity of health professionals (rheumatologists, general practitioners, orthopedists, physiotherapists, MPR specialists, sports doctors, etc.). These recommendations aim to harmonize practices in a context where several North American, European and international learned societies have also published guidelines.
