Evidence based treatment
Professor Rachelle Buchbinder, rheumatologist
Evidence-based medicine is the careful use of the best evidence to make the best decisions about individual patient care. In a practical sense this means integrating the clinicians expertise with the best available evidence and incorporating patient preference to make sure that patients received the best treatment for any given situation. It's really important that healthcare professionals track down the best available evidence to inform the management of their patients and this ensures that the patient's really receive via optimal care.
Professor David Hunter, rheumatologist
The best treatments for osteoarthritis really involves looking at the holistic management of the disease and there I mean specifically paying attention to why you developed osteoarthritis in the first place and paying particular attention to nonpharmacologic, non-medication, non-surgical treatments in the first instance and that's what most guidelines would advocate for. So, I'm there thinking about trying to particularly focus on if you're overweight and obese losing ways particularly if you're sedentary or your muscles around your joints are not particularly strong trying to improve muscular strength aerobic or cardiovascular fitness as well and again if you're depressed and/or if you've got significant psychological impairment either as a consequence of the disease or as a complete separate entity, paying particular attention to the treatment and management of that as well. Following appropriate non pharmacologic conservative management: weight loss, exercise, using braces, paying attention to psychological needs then it might be appropriate to use analgesic medication pain relieving medications such as anti-inflammatories, topical ointments, that may help to facilitate the treatment of the disease. If they are also ineffective at managing that the symptoms that relate to the disease then surgery may be an option.
Quality physiotherapy care
Professor Rana Hinman, physiotherapist
A quality physiotherapy care for arthritis should involve quite a bit of time and dialogue between the physio and the patient taking quite a good bit of time to get to know you and the problem and how you've managed that condition and to really work out what it is that you need and want for managing your problem because it does differ across different patients. There's no recipe for arthritis but there are a couple of very key core components that are essential to quality physiotherapy care these include a quite an individualised tailored exercise program for your condition so whether it be your hip or your hand or your knee a structured, somewhat prescribed, exercise program that you can undertake on a regular basis you know roughly rule of thumb three times a week should incorporate some muscle strengthening exercises perhaps some flexibility exercises if that's appropriate for you as well as some aerobic exercise is really critical and an essential component.
Alongside that though is it's not just about a structured exercise program that you undertake you know a couple of times a week and that's enough, but it's also about general physical activity or incidental activity so, quality physio program will also involve a bit of a discussion with ways and means that you can increase your general physical activity levels and it doesn't have to mean that you're going to be going for a run or you know walking around the block for two hours every day often it could be simple strategies that can be built into your daily activities as well, so a real focus on physical activity.
If you're overweight a discussion around strategies to help you lose weight or perhaps even discussing options for who you might be referred to who can further help you to minimise and keep your weight down and the flip side of that for people who aren't overweight it's really important that they don't put on weight because that really does increase the forces and the stress across the joints and so that's really particularly relevant if you've got hip or knee arthritis.
Another sign of good physio is that you won't necessary we require multiple visits in a short timeframe and in fact that's probably not going to be best for you, self-management and exercise really requires regular visits but we with an interval in between so it may well be quite appropriate that after your first visit you don't need to see the physio again for several weeks or perhaps if the physio thinks perhaps not for a month or so but some regular follow-ups to check how you're going and progress your exercise program because that's also quite important is that being given an exercise program on day one is fantastic but that doesn't mean that that's that same exercise program will be appropriate for you in six months’ time. So, quality physio should build in a regular follow-up at intervals over the long term to make sure that that activity and exercise program can be tweaked to suit you as your circumstances and your joint conditions change for example. One other sign of quality physio is largely a hands-off approach to management rather than a physical hands-on approach by the therapists certainly for a proportion of patients there will be manual techniques that will be appropriate that will depend on your assessment so the physiotherapists may decide some massage or joint mobilisation or taping techniques might be appropriate for you but that won't necessarily be for everybody certainly there's not a lot of research evidence to support the use of many electrotherapy devices that people might be familiar with such as ultrasound or laser or interferential devices and so we wouldn't be expecting that that should form a large component or really play any major role in quality physiotherapy care for arthritis.
