A measurement of knee osteoarthritis usual careTerug naar alle onderzoek rond Kwaliteit »


  • David Spitaels


  • Patrik Vankrunkelsven 
  • Bert Aertgeerts
  • Rosella Hermens
  • Frank Luyten


Osteoarthritis (OA) is the most common affection of joints worldwide. It is the second responsible of moderate and severe disability in high-income countries and a leading cause of disability in the elderly.(1, 2) Suffering from knee pain on a daily base is common within nearly 25% of total population in the USA aged 55 years or more! Pain and limitation of motion due to OA are a main cause of social isolation in the elderly.(2) Ageing of total population and obesity will increase the prevalence of OA and are expected to make osteoarthritis the fourth leading cause of disability by the year 2020.(3, 4)

International guidelines on the approach and treatment of knee OA are still available.(5-12) Nevertheless there is a gap between usual care and the preferred one as described in the guidelines. Generally, American adults receive hardly 55% of recommended care.(13) Quality of OA care within primary care in the US seems to be suboptimal among patients aged ≥ 75 years, which is consistent with UK data. Education about the condition, advise on the side effects of NSAID treatment and annual assessment for functional status and degree of pain overall score low.(14, 15) Guideline adherence in France is only approximately 54% for both non pharmacological and pharmacological recommendations, although most physicians agree with the EULAR 2000 recommendations.(16) Exercise therapy appears to be underused, under-advised and under-prescribed by general practitioners (GPs).(17) In addition a study of Dexter et al shows a minority of patients, undertaking exercises, is performing these correctly and regularly.(18) Arthroscopic surgery, instead, is frequently used for the treatment of knee OA, though there seems to be no additional benefit to physical and optimized medical therapy.(19, 20) Obviously there are some barriers to implement current guidelines properly. According to Grol 'guidelines do not implement themselves'!(21) The obstacles to change have to be mapped and explored in order to develop an effective implementation intervention.(22)

Actually there are no data about guideline adherence on the approach and treatment of knee OA in Flanders. Neither there are guidelines or protocols adapted to the Belgian health care system. Therefore a set of knee osteoarthritis process quality indicators was developed by a multidisciplinary expert panel, according to the RAND-modified Delphi Method and based on multiple international guidelines and existing sets of quality indicators.(23) This project aims to map the quality of knee OA care in Flanders to explore the barriers and facilitators for the gaps between usual care and the preferred one. Based on the current care and the barriers and facilitators, an implementation strategy may be developed and tested in a feasibility study in order to enhance adherence afterwards. Improvements in evidence-based care and enhancing guideline adherence are likely to reduce the burden of disability, caused by this disturbing condition!(24-26)


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2. Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson P, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994;84:351.

3. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;41:778-99.

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6. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62. Epub 2008/02/19.

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9. Zhang W, Nuki G, Moskowitz R, Abramson S, Altman R, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010;18:476-99.

10. Zhang W, Doherty M, Peat G, Bierma-Zeinstra M, Arden N, Bresnihan B, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 2010;69:483-9.

11. The Royal Australian College of General Practitioners. Recommendations for the non-surgical management of hip and knee osteoarthritis. South Melbourne: RACGP, 2009.

12. Peter WFH, Jansen MJ, Bloo H, Dekker-Bakker LMM, Dilling RG, Hilberdink WKH, et al. Revision of the KNGF Guideline Osteoarthritis of the Hip and Knee [Dutch]. Nederlands Tijdschrift Voor Fysiotherapie 2010;120:2-15.

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14. Ganz DA, Chang JT, Roth CP, Guan M, Kamberg CJ, Niu F, et al. Quality of osteoarthritis care for community‐dwelling older adults. Arthritis Care Res 2006;55:241-7.

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16. Denoeud L, Mazieres B, Payen-Champenois C, Ravaud P. First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence. Ann Rheum Dis 2005;64:70.

17. Cottrell E, Roddy E, Foster N. The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review [review]. BMC family practice 2010;11:4.

18. Dexter P, Brandt K. Relationships between social background and medical care in osteoarthritis. J Rheumatol 1993;20:698-703.

19. Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011;93:994-1000. Epub 2011/05/03.

20. Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008;359:1097-107.

21. Grol R, Wensing M, Eccles M. Improving patient care: the implementation of change in clinical practice: Elsevier Butterworth Heinemann Edinburgh; 2005.

22. Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418-21. Epub 1997/08/16.

23. Campbell SM, Cantrill JA, Roberts D. Prescribing indicators for UK general practice: Delphi consultation study. BMJ 2000;321:425-8. Epub 2000/08/11.

24. Carlhed R, Bojestig M, Peterson A, Aberg C, Garmo H, Lindahl B. Improved clinical outcome after acute myocardial infarction in hospitals participating in a Swedish quality improvement initiative. Circ Cardiovasc Qual Outcomes 2009;2:458-64. Epub 2009/12/25.

25. Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA 2006;295:1912-20. Epub 2006/04/28.

26. Micieli G, Cavallini A, Quaglini S. Guideline compliance improves stroke outcome: a preliminary study in 4 districts in the Italian region of Lombardia. Stroke 2002;33:1341-7. Epub 2002/05/04.

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