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Research ArticleAccepted Article

Use of recommended non-surgical knee osteoarthritis management in patients prior to totalv knee arthroplasty: a cross-sectional study

Lauren K. King, Deborah A. Marshall, Peter Faris, Linda Woodhouse, C. Allyson Jones, Tom Noseworthy, Eric Bohm, Michael Dunbar and Gillian A. Hawker on behalf of the BEST-Knee Team
The Journal of Rheumatology November 2019, jrheum.190467; DOI: https://doi.org/10.3899/jrheum.190467
Lauren K. King
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Deborah A. Marshall
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Peter Faris
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Linda Woodhouse
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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C. Allyson Jones
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Tom Noseworthy
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Eric Bohm
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Michael Dunbar
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Gillian A. Hawker
Department of Medicine, University of Toronto, Toronto, ON Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada; Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada. This study was funded by an operating grant from the Canadian Institutes of Health Research, grant # MOP-312807. Gillian Hawker has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. Deborah Marshall is supported through a Canada Research Chair in Health Systems and Services Research and the Arthur J.E. Child Chair in Rheumatology. All other authors declare no conflicts of interest related to the work under consideration for publication. Address correspondence to Dr. Gillian A. Hawker, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario, Canada M5G 2C4, Telephone: 416-946-8071; FAX: 416-978-7230; E-mail: g.hawker@utoronto.ca.
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Abstract

Objective Our aim was to assess prior use of core recommended non-surgical treatment among patients with knee osteoarthritis (OA) scheduled for total knee arthroplasty (TKA); and, to assess potential patient-level correlates of underuse, if found.

Methods This was a cross-sectional study of patients undergoing TKA for primary knee OA at two provincial central intake hip and knee clinics in Alberta, Canada. Standardized questionnaires assessed socio-demographic characteristics, social support, coexisting medical conditions, OA symptoms and coping, and previous non-surgical management. Multivariable logistic regression was used to assess the patient-level variables independently associated with receipt of recommended non-surgical knee OA treatment, defined as prior use of pharmacotherapy for pain, rehabilitation strategies (exercise or physiotherapy), and weight loss if overweight or obese (body mass index ≥25 kg/m2).

Results 1,273 patients were included: mean age 66.9 years [SD 8.7]; 39.9% male; 44.1% had less than post-secondary education. Recommended non-surgical knee OA treatment had been used by 59.7% of patients. In multivariable modeling, the odds of having received recommended non-surgical knee OA treatment was significantly and independently lower among individuals who were older (OR 0.96 [95%CI 0.95–0.98]), male (OR 0.41 [0.31–0.53]), and who lacked post-secondary education (OR 0.67 [0.52–0.87]).

Conclusion In a large cross-sectional analysis of knee OA patients scheduled for TKA, 40% of individuals reported having not received core recommended non-surgical treatments. Older individuals, men and those with less education had lower odds of having used recommended non-surgical OA treatments.

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The Journal of Rheumatology
Vol. 50, Issue 2
1 Feb 2023
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Accepted manuscript
Use of recommended non-surgical knee osteoarthritis management in patients prior to totalv knee arthroplasty: a cross-sectional study
Lauren K. King, Deborah A. Marshall, Peter Faris, Linda Woodhouse, C. Allyson Jones, Tom Noseworthy, Eric Bohm, Michael Dunbar, Gillian A. Hawker
The Journal of Rheumatology Nov 2019, jrheum.190467; DOI: 10.3899/jrheum.190467

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Accepted manuscript
Use of recommended non-surgical knee osteoarthritis management in patients prior to totalv knee arthroplasty: a cross-sectional study
Lauren K. King, Deborah A. Marshall, Peter Faris, Linda Woodhouse, C. Allyson Jones, Tom Noseworthy, Eric Bohm, Michael Dunbar, Gillian A. Hawker
The Journal of Rheumatology Nov 2019, jrheum.190467; DOI: 10.3899/jrheum.190467
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