 |
|
|
 |
Knee Osteoarthritis Clinical Practice Guidelines — How Are We Doing? MELANIE N. DeHAAN, JAIME GUZMAN, MARK THEODORE BAYLEY, and MARY J. BELL
ABSTRACT. Methods. The charts of 105 randomly selected patients meeting criteria for knee OA were reviewed. The patients received care from 3 rheumatologists working in a major Canadian teaching center between 2002 and 2005. The chart abstraction tool was based on European League Against Rheumatism, American College of Rheumatology, and The Arthritis Society guidelines for OA treatment. Descriptive statistics were used for patient demographics and the proportion of patients receiving recommended care. Results. The most frequently recommended nonpharmacologic treatments were any kind of exercise (58.1%), weight loss in those overweight (50.0%), physiotherapy (42.9%), and strengthening exercise (40.0%). Other nonpharmacologic treatments were documented in less than 30% of patient charts. The most frequently prescribed pharmacologic treatments were acetaminophen (68.6%), intraarticular (IA) corticosteroids (65.7%), nonsteroidal antiinflammatory drugs/cyclooxygenase-2-selective inhibitors (COXIB; 50.5%), and IA hyaluronans (43.8%). Topical pharmaceuticals, glucosamine/chondroitin, and opioid analgesics were recommended to less than 20% of the patients. Exploratory analyses suggested the following factors may be associated with increased documentation of recommended care: female sex, younger age, overweight, more clinic visits, decreased symptom length, and the individual rheumatologist. Conclusion. Nonpharmacologic knee OA treatments currently recommended by practice guidelines were seldom documented in patients' charts in this Canadian rheumatology teaching center. These findings are similar to studies conducted before the practice guidelines became available and to results reported from general practices. This suggests the need for reminder systems or other strategies to promote physician adherence to current guidelines. (First Release Aug 15 2007; J Rheumatol 2007; 34:2099-105) Key Indexing Terms:
OSTEOARTHRITIS From the Division of Physiatry, Division of Physical Medicine and Rehabilitation, and Division of Rheumatology, Department of Medicine, University of Toronto; Toronto Rehabilitation Institute; Division of Rheumatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario; Occupational Health and Safety Agency for Healthcare in British Columbia; and University of British Columbia, Victoria, BC, Canada. M.N. DeHaan, BSc(Eng), MD, Division of Physiatry, Department of Medicine, University of Toronto; J. Guzman, MD, MSc, FRCPC, Scientific and Medical Director, Disability Prevention, Occupational Health and Safety Agency for Healthcare in British Columbia, and Clinical Assistant Professor of Medicine, University of British Columbia; M.T. Bayley, BA, MD, FRCPC, Scientist, Toronto Rehabilitation Institute and Associate Professor, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; M.J. Bell, MD, MSc, FRCPC, Head, Division of Rheumatology, Department of Medicine, Sunnybrook Health Sciences Centre, Associate Professor, Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto. Address reprint requests to Dr. M.N. DeHaan, Toronto Rehabilitation Institute — University Centre, Ste. 211, 550 University Ave., Toronto, ON M5G 2A2, Canada. Accepted for publication June 27, 2007. |
