Osteoarthritis of the Knee
Large Review Confirms Efficacy of In-Home Physical Therapy
Osteoarthritis causes more disability in walking, stair climbing, and housekeeping than any other disease.¹ Lower extremity weakness is common in osteoarthritis of the knee. Strengthening, coordination, and aerobic improvement may decrease joint loading rate and stresses on articular cartilage, thereby playing an important role in ameliorating the progression of osteoarthritis. A referral for physical therapy has long been part of recommendations for treatment options, and new evidence confirms and qualifies the efficacy of such referrals.
Recently, the British Journal of Sports Medicine published the largest systematic review to date for standard exercise therapy approaches for osteoarthritis of the knee.² More than 54 randomized, controlled trials covering 5,362 participants now make up the body of evidence, which the GRADE approach assesses as high quality. The review finds that standard physical therapy approaches produce moderate improvements in pain during treatment with statistically significant improvements in pain, function, and quality of life persisting at six-month follow-up.
Marlene Fransen and colleagues combined the results of studies comparing interventions including supervised strengthening and / or aerobic conditioning compared to non-exercise controls. Across studies, physical therapy sessions ranged from 20 minutes to 60 minutes. Most frequencies were two to three times per week, but some were one or five times per week. More sessions in the first weeks correlated with faster pain relief, suggesting advantages to a pattern of front-loading the therapy visits. Contrary to this review’s 2008 predecessor,³ providing more than 12 supervised exercise sessions did not change the results compared to proving fewer than 12 sessions.
Interestingly, results did not differ whether professionally supervised exercise programs were administered at home or in facilities. For homebound patients with a recent medical occurrence such as an increase in pain or disability, this means doctors can confidently refer to home health for osteoarthritis rehab. For Medicare beneficiaries, a referral to home health means greater convenience and no deductibles or co-pays. Furthermore, this study evaluated exercise therapies in isolation. Five Star Home Health works to further optimize outcomes through a multidisciplinary and holistic approach. In addition to exercise therapy, we can evaluate the home for fall safety and equipment improvement opportunities. Nurses can help patients ensure adherence with the doctor’s intended medication regimen and provide nutrition coaching. Occupational therapists can devise energy conservation strategies and other techniques to improve each patient’s ability despite geriatric decline in function. For your home- bound patients with a recent medical occurrence, you can refer to a complete osteoarthritis rehab program designed to improve your patient’s ability and quality of life, long-term.
Providing Both Interim and Long-Term Home Care
When patients have disabilities, dementia, or problematic mobility, refer to Five Star Home Health because we provide both Medicare-certified home health for short-term medical needs and personal care for long-term, largely non-medical services. We can provide the continuity of care your patients with disabilities may need to live safely at home long term. Click here to submit a referral.
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