BOA background
Traditionally osteoarthritis has been viewed upon as a disease where nothing can be done [14, 15]. There is currently no cure for osteoarthritis but there are several ways to alleviate the discomfort, reduce the disability and delay the progress of the disease. With the support and guidance of health care workers patients can do much themselves. The core treatment is exercise, information and weight control [16-20]. These treatments should be offered all patients with osteoarthritis as early as possible during the course of disease.
Referral to physical therapist is recommended in international guidelines for osteoarthritis [18], however only about 10% of patients with osteoarthritis have seen a physical therapist [21-23]. Instead, treatment often focuses on symptom relief, using drugs. In the case of insufficient effect from pain relieving drugs, patients are often referred to radiographic examination, and orthopaedic surgeon, to evaluate the need for joint replacement. Most patients will never need surgery, and only about 10% of all patients with osteoarthritis will become surgical candidates [24]. Too many patients are put on waiting lists, and later told there is nothing that can be done, despite existing treatment guidelines [25].
Long waiting lists without active treatment increase the risk of loss of function and sick leave. The costs for sick leave as a result of osteoarthritis are significant, primarily because of the long time required for improvement and that so many people are affected. The cost for knee osteoarthritis alone in 2000 amounted to1,2 % of the total cost of sick leave in Sweden, approximately 460 million Swedish crowns. The total economic burden to society for osteoarthritis in Sweden in 2001 was nearly 12 billion Swedish crowns. Of this sum, 84% was related to sick leave, early retirement and loss of production (CMT report 2003:5).
Physical therapists and occupational therapists are underused. A study of 1200 patients in the south west of Sweden, having total hip replacement during one year (2004) due to osteoarthritis, that only about 45% had seen a physical therapist before surgery. (Sjödahl K, Lund University, master thesis, 2007). This study also showed that patients receiving non-surgical treatment before surgery perceived higher quality of life at one year follow up after surgery compared with the group who had not seen a physical therapist.
By recommending patients to start exercising and lose weight if needed, and inform about the effects this might have on symptoms, patients can be spared a lot of suffering and frustration. Education and information is needed to implement this knowledge in health care, and to get it accepted by decision makers and patients [26].