Authors (including presenting author) :
Lee WWY(1), Ngai RMP(1), Ko WWK(2), Kwong ASK(2), Lam PL(3), Chan GNY(1)
Affiliation :
(1) Physiotherapy Department, David Trench Rehabilitation Centre; (2) Department of Family Medicine & Primary Healthcare, Hong Kong West Cluster; (3) Physiotherapy Department, Queen Mary Hospital
Introduction :
Twenty percent of the populations worldwide are affected by OA knee. In such a large population, different disease severities require different management approaches. Exercise education classes have been carried out by physiotherapists in different formats in general out-patient clinics(GOPCs) under the Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster and in physiotherapy out-patient setting(PTOPD) in David Trench Rehabilitation Centre. In GOPCs, patients are provided with a home-based self-empowerment program with two sessions of education, advice and exercise; In PTOPD, a 4-session supervised group exercise program is offered with physiotherapy interventions provided in addition to education and exercise.
Objectives :
(1)To evaluate the characteristics of patients in physiotherapist-led primary care service in GOPCs & PTOPD; (2)To evaluate the improvement of patients with different management strategies.
Methodology :
Patients with a diagnosis of OA knee were referred to physiotherapist-led primary care service in GOPCs or PTOPD according to the severity of symptoms. Outcome measures included Numeric Global Rating of Change Scale(NGRCS) and Knee injury and Osteoarthritis Outcome Score - Physical Function Shortform(KOOS-PS). They were taken in the first session and in a one-month telephone follow-up in GOPCs and during the first and last sessions in PTOPD.
Result & Outcome :
545 patients attending the programs in GOPCs & PTOPD were reviewed up to one year and nine months. Drop-out rates in both programs were below 10%. Mean age of the patients was 63.8 in GOPCs and 64.7 in PTOPD. The baseline KOOS-PS score was higher in GOPCs(72.3, mild symptoms) and lower in PTOPD(66.5, moderate symptoms)(p=0.001). Mean NGRCS after the program was 4.6 in NAHC and 4.2 in PTOPD. Mean KOOS-PS score improved from 72.3 to 83.3 in GOPCs(p<0.001) and from 66.5 to 69.5 in PTOPD(p<0.001).
There were significant improvements in the functions of patients with knee OA in both GOPCs and PTOPD programs. Patients were adherent to the programs and the programs improved their confidence in the self-management of the disease. Patients were referred to the appropriate care process in a cost-effective way under a stepped-care approach based on their severity scores: patients with mild symptoms benefited from the self-empowerment program in GOPCs and those with moderate symptoms showed improvement in the supervised exercise program in PTOPD. Early referral should be encouraged to avoid symptom development and provide patients with prophylactic self-management techniques.
Co-location with:
