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“Beating osteoARThritis”: Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

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Abstract

Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an evidence-based, multidisciplinary, patient-centered, stepped care strategy. A national, multidisciplinary, steering group developed the strategy in three phases: (1) consensus among steering group members (first draft); (2) written consultation of 23 representatives of patient organizations and professional associations involved in osteoarthritis care (second draft); (3) consensus of the final draft after discussion in two rounds during a conference with representatives from the different disciplines. The final stepped care strategy presents, in three tiers, the optimal order for non-surgical treatment modalities. It recommends that more advanced options should only be considered if options listed in previous steps failed to produce satisfactory results. Hence, the first step treatment options can be offered to all patients but may also be provided through self care (education, life style advice, and acetaminophen). The second step (exercise therapy, dietary therapy, and non-steroidal anti-inflammatory drugs) and third step treatment options (multidisciplinary care, intra-articular injections, and transcutaneous electrical nerve stimulation) can be considered for people with persisting complaints. Trough a consensus procedure, we succeeded to develop a multidisciplinary, patient-centered, stepped care strategy based on national guidelines. This strategy provides a framework for health care providers and patients with hip or knee osteoarthritis to discuss the optimal timing of the various treatment options.

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Acknowledgements

The authors are indebted to the participants of the written consultation and invitational conference for their contribution in the development of the stepped care strategy. Our thanks go to Hans Bloo, Roessingh Research & Development, Enschede; Alfons den Broeder, Department of Rheumatology, Sint Maartenskliniek, Nijmegen; Sjoerd Bulstra, Department of Orthopaedics, University Medical Center Groningen; Martin van der Esch, Department of Rehabilitation and Rheumatology, Reade, Amsterdam; Wim Hilberdink, Paramedical center for rheumatology and rehabilitation, Groningen; Ria Jansen, Patient Society Poly-Osteoarthritis Companions, Hoogerheide; Caroline Kielstra, Bone and Joint Decade NL, Leiden; Margreet Kloppenburg, Department of Rheumatology, University Medical Center, Leiden; Marianne Krijgsman, Dutch patient organization for rheumatic diseases, Amersfoort; Annet Lievense, Department of General Practice, Erasmus University Medical Center Rotterdam; Sjoerd Olthof, Royal Dutch Society for Physical Therapy, Utrecht; Rob Oostendorp, Dutch Institute of Allied Health Care, Amersfoort; Wim Opstelten, The Dutch College of General Practitioners, Utrecht; Susan Picavet, National Institute for Public Health and the Environment, Bilthoven; Ruud Pöll, EMGO Institute for Health and Care Research VU University Medical Center, Amsterdam; Victor Pop, Faculty of Social and Behavioural Sciences, Tilburg University; Peter van Roermund, Bone and Joint Decade NL, Leiden; Marieke Scholte, Bone and Joint Decade NL, Leiden; Rosalinda Schuil-Menninga, Paramedical center for rheumatology and rehabilitation, Groningen; Gijs Snijders, Department of Rheumatology, Sint Maartenskliniek, Nijmegen; Cindy Veenhof, Netherlands Institute for Health Services Research, Utrecht; Cora Verberk; Gust Verbruggen, Department of Rheumatology, Ghent University Hospital, Belgium; Jan Verhaar, Department of Orthopaedics, Erasmus University Medical Center Rotterdam; Kees Verheijen, Department of Orthopaedics, Isala clinics, Zwolle; Geert Walenkamp, Department of Orthopaedics, Maastricht University Medical Center, Research Institute Caphri.

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Correspondence to Agnes J. Smink.

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Smink, A.J., van den Ende, C.H.M., Vliet Vlieland, T.P.M. et al. “Beating osteoARThritis”: Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clin Rheumatol 30, 1623–1629 (2011). https://doi.org/10.1007/s10067-011-1835-x

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  • DOI: https://doi.org/10.1007/s10067-011-1835-x

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