A study published in Arthritis Care & Research analyzed current trends in the treatment of osteoarthritis (OA) of the knee. Per the findings, the rate of nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotics prescriptions is on the rise, while lifestyle recommendations are on the decline.
The cross-sectional study included National Ambulatory Medical Care Survey data spanning 2007–2015. Researchers identified visits to orthopedists and primary care physicians related to knee OA and assessed each visit for the following: physical therapist (PT) referral, lifestyle counseling, NSAIDs prescriptions, and narcotics prescriptions. They calculated triennial rates for each treatment and observed correlations between patient (e.g., race, insurance), physician and practice factors (e.g., ownership, location), and treatment prescribed.
NSAIDs, Narcotics Trump Lifestyle Changes
Final analysis included 2,297 physician visits pertaining to knee OA (~67 [±4] million weighted-visits). Among orthopedist visits, there was a decline in PT recommendation (158/1,000 to 88/1,000) as well as lifestyle recommendation (184/1,000 to 86/1,000) rates; meanwhile, there was an increase in the rates of prescriptions for NSAIDs (132/1,000 to 278/1,000) and narcotics (77/1,000 to 236/1,000) overtime (P < 0.05). Among primary care physicians, there were no significant changes in rates of lifestyle and PT recommendations or narcotics use, but NSAIDs prescriptions increased significantly (221/1,000 to 498/1,000, P < 0.05). Treatment recommendations were correlated with practice type, location, and type of provider seen.
“Our major takeaway from this research is that patients might not be receiving optimum care for knee osteoarthritis. Physicians seem more focused on helping their patients manage their pain with medications, but it is also important to consider the long-term benefits of exercise for mitigating declines in physical health,” said lead author Samannaaz Khoja, PT, PhD, research assistant professor at the University of Pittsburgh School of Health and Rehabilitation Sciences’ Department of Physical Therapy, in a press release. “Despite being part of clinical practice guidelines, exercise-based interventions are still being prescribed at a very low rate. More research is needed to determine barriers to prescribing exercise.”