Best practice management of acute as well as long-term care for patients with osteoarthritis includes optimal use of medicines, non-pharmacological management, appropriate care and referral pathways, patient self-management education and psychosocial support. Non-pharmacological interventions generally have low or no side effects and are used in conjunction with a pharmacological regimen to decrease pain and promote functioning and quality of life.
The guide makes the following recommendations for non-pharmacological therapy:
- Regular exercise is important for relieving pain and improving function in people with knee and/or hip osteoarthritis. For knee osteoarthritis, land-based exercise such as muscle strengthening, walking and Tai Chi are strongly recommended. Other land-based exercise that could be considered for some people include stationary cycling and Hatha yoga. The best land-based exercise for people with hip osteoarthritis could not be determined because of limited research. Aquatic exercise may be considered for some people with knee and/or hip osteoarthritis.
- Weight management is strongly recommended for people with knee and/or hip osteoarthritis who are overweight or obese. Cognitive behavioural therapy could be considered for some people, particularly in conjunction with exercise, and taking into account existing mental health conditions, personal preference, cost and access.
- Heat packs or hot water bottles may be applied as a self-management strategy.
- Using a cane or other devices (eg, walker, crutches) may be appropriate for some people with knee and/or hip osteoarthritis to help improve pain, mobility and balance.
- A short course of manual therapy or massage could be considered for some people with knee and/or hip osteoarthritis as an adjunct to lifestyle management.
- Transcutaneous electrical nerve stimulation that can be used at home may be appropriate for some people with knee and/or hip osteoarthritis.
- There is a conditional recommendation against the following treatments: therapeutic ultrasound, shockwave therapy, laser therapy, interferential therapy, footwear marketed for knee osteoarthritis, cold therapy, valgus braces and lateral wedge insoles for medial knee osteoarthritis, patellofemoral braces and Kinesio Taping.
Due to a lack of high-quality evidence, no recommendation can be made for the following: formal self-management programs, varus unloading braces and medial wedge insoles for lateral knee osteoarthritis, shock-absorbing insoles, arch supports, patellar taping and pulsed electromagnetic/shortwave therapy.
The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.