Osteoarthritis Health Professional Training Manual

Front Cover
Osteoarthritis Health Professional Training Manual
Osteoarthritis Health Professional Training Manual
Copyright
Contents
Contributors
Preface
1 - Introduction to OA, communication, and person-centered care
Introduction
Section 1a: Etiopathogenesis and epidemiology of osteoarthritis
What is osteoarthritis?
How does osteoarthritis develop?
How common is osteoarthritis?
Impact and burden of osteoarthritis
Section 1b: Communication skills that support best evidence osteoarthritis care and Section 1c: person-centered care
What is best evidence osteoarthritis care?
What is person-centered care?
Compassionate communication
Curious communication
Critical communication
Collaborative communication
What are additional considerations in the uptake of best practice osteoarthritis care?
Concluding remarks
Key points
Multi-choice questions
References
2 - Module 2: history taking and physical assessment
Brief introduction to the chapter
History taking
Introduction
The importance of communication in eliciting accurate information
A holistic approach to history taking
Symptom assessment
Participation restrictions
Previous medical history
Comorbidities
Psychological factors
Sleep and fatigue
Support network
Attitudes and beliefs
Screening for red flags
Use of recognized person reported outcome measures
Goal setting
Key elements of documentation
Summary
Physical assessment
Introduction
Preparing for and undertaking the physical assessment
Content of the physical examination
Look
General observation
Joint specific observation
Gait observation
Feel
Palpation
Move
Range of motion assessment
Measure
Muscle strength and length/tightness
Neurological features
Special tests
Specific content for physical examination of the knee, hip, and wrist/hand
Knee examination
Special tests for the knee
Hip examination
Special tests for the hip
Wrist/hand examination
Special tests for the hands
Summary
Clinical practice points
Concluding remarks
References
3 - Diagnosis, risk factors for OA development and progression, OA prevention, and recognizing comorbidities
Introduction
OA incidence
Impact of OA
OA diagnosis
Clinical diagnosis
Early-stage OA
Use of additional diagnostics by imaging or laboratory tests
Holistic approach
Risk factors
Age
Sex
Race/ethnicity
Overweight/obesity
Joint injury, habitual and occupational physical activities
Nutritional factors
Vitamin D
Vitamin K
Selenium
Dietary fiber
Bone mineral density
Joint shape and alignment
Muscle strength
Genetics
Risk factors for symptomatic OA
OA prevention
Primary prevention
Preventing knee injury
Interventions after knee injury
Interventions for hip dysplasia
Interventions for cam deformity or FAIS
Secondary prevention
OA and comorbidities
References
4 - Core components of best evidence OA care: management planning, education, supporting self-management and behavi ...
Introduction to core components of best evidence OA care
Key components of best evidence OA care
Brief summary of evidence supporting core components of best evidence OA care
Education and support for self-management
Increasing physical activity and exercise
Weight management
A comprehensive approach to osteoarthritis management
Utilizes a biopsychosocial approach and perspective
Interdisciplinary coordinated care
Key elements: self-efficacy, goals, strengths and available resources, and behavior change techniques
Self-efficacy
Goal-driven
Considers individual strengths and available resources
Incorporates a range of behavior change techniques
Approaches to monitoring treatment progress and adjusting management plans
Regular monitoring
Use validated psychosocial tools to aid in assessment and to support monitoring
Regularly review plan and adjust
Purpose and importance of education and support for self-management
Self-management support strategies
Responding to emotions
Need for a framework
Behavior change: why should we use a theoretical framework?
Common elements of behavior change theory
A social cognitive framework: social cognitive theory
Promoting self-efficacy: the central element
Feedback loops: relationship among past behavior, self-efficacy, and performance
Case study
Background information
Relationship building and assessment
Soliciting the main concern
Using a social cognitive framework – intervention
Follow-up and evaluation
References
5 - Physical activity, exercise, and therapeutic exercise
What is physical activity, sedentary behavior, exercise, and therapeutic exercise?
Recommendations for physical activity in OA
Consequences of physical inactivity and sedentary behavior in OA
Types of exercises that are beneficial for people with OA
Cardiovascular (aerobic) fitness
Resistance (strength) training
Flexibility (stretching) exercise
Neuromotor (neuromuscular) exercise
Mind-body exercise
Counselling-based physical activity promotion
Mechanisms of exercise benefits
Safety of physical activity and therapeutic exercise
Principles of exercise prescription and progression for OA
Overcoming barriers to physical activity and exercise participation
Services and supports to facilitate engagement in physical activity and exercise for people with OA
Increasing adherence to home exercise
Activity pacing and behavioral graded activity for people with OA
References
6 - Module 6: core components of best evidence OA care – weight control
AIMS
A brief introduction to the chapter
Effect of weight control in OA pain management and OA disease progression
Overweight or obesity is a strong risk factor for OA
Mechanisms of body weight contributing to the development and progression of OA
Benefits of weight loss in OA
Other benefits of weight loss
Diet and OA: Summary of dietary components and their effects on the prevention and management of OA
Diet and weight loss
Antiinflammatory diets
Dietary components
Meal replacement and low caloric diets
Patient-centered weight control to manage OA
How can we best support people with OA to lose body weight?
How to maintain weight loss?
Safety considerations
Barriers to implementing weight control in persons with OA
Overall factors for weight loss
Patient level
Lack of motivation to lose weight or change habits
Pain as a barrier to losing weight and exercise
Healthy eating
Clinician level
Lack of communication from healthcare providers
Guideline adherence
Lack of time (patients and clinicians)
Concluding remarks
Selected links to any helpful online resources
Europe
US
Asia
Australia
Africa
Case study 3: Katrina
References
7 - Module 7: adjunctive rehabilitative interventions
Introduction to adjunctive rehabilitative interventions
Biomechanical devices and strategies
Varus/valgus unloader braces
Patellofemoral bracing
Hip bracing
Medial and lateral wedges or insoles
Footwear
Walking poles
Gait retraining
Electrical stimulation for pain management
Classic rehabilitation approaches
Manual therapy
Taping
Assistive devices
Thermal modalities
Complementary alternative medicine
Yoga and pilates
Tai chi and acupuncture
Psychosocial strategies
Summary and concluding remarks
References
8 - Pharmacotherapy
Aims for module
Role and rationale of pharmacotherapy in OA management
Oral medications
Acetaminophen (paracetamol)
Nonsteroidal antiinflammatory drugs (NSAIDs)
Mechanism of action
Adverse effects – all NSAIDs
Adverse effects – contrasts between nonselective NSAIDs and COX-2 selective NSAIDs
Key points
Opioids
Adjuvant analgesics
Topical therapies
Capsaicin
Topical NSAIDS
Intraarticular therapies
Corticosteroids
Hyaluronan products
Platelet-rich plasma
Stem cell therapy
Dextrose prolotherapy
Key points
Dietary supplements/nutraceutical products
Glucosamine sulfate
Chondroitin
Fish oil/krill oil
Vitamin D
Vitamin K
Avocado soybean unsaponfiables (ASU)
Collagen
Methylsulfonylmethane (MSM)
Tumeric/curcumin
Boswellia serrata
Pycnogenol
Key points
Experimental therapies
Concluding remarks
References
9 - Surgery for osteoarthritis
Indications for surgery
Surgical options for osteoarthritis
Procedures for hip osteoarthritis
Total hip replacement
Pelvic osteotomy
Procedures for knee osteoarthritis
Total knee replacement
Unicompartmental knee replacement
Patellofemoral replacement
High tibial osteotomy
Risks of surgery
General
Specific risks related to total joint replacement
Preoperative preparation
General fitness
Comorbidities
Infections
Anesthetic and postoperative pain relief
Postoperative course
In hospital – Early Recovery After Surgery (ERAS)
First 6weeks
First 12months
Measuring outcomes
Patient expectations and satisfaction
Acknowledgments
References
10 - The interprofessional team, service delivery, and professional development
Introduction
Principles underpinning successful delivery of care
Support for self-management of osteoarthritis
Person-centered care
The Chronic Care Model
Interprofessional and multidisciplinary care
Exploring health and nonhealth considerations for delivering care
The healthcare team
Who should be delivering osteoarthritis care?
The role of the health professionals in delivering osteoarthritis care
When should we on-refer patients to other professionals?
Delivering and coordinating osteoarthritis care
Phase i. Education and understanding
Person-centered care considerations
Clinical assessments
Phase ii. Planning and goal setting
Treatment domains
Independent self-management options
Phase iii. Ongoing support and treatment progression
Phase iv. Long-term joint health
Thinking beyond health care—integrating care into everyday life
What are social determinants of health?
Concepts underpinning social determinant considerations for osteoarthritis care
Pathways of care and adapting them to suit different settings
Enhancing osteoarthritis care in lower-resourced settings
Incorporating evidence-based care into your clinical practice
Using the evidence pyramid (levels of evidence) in evidence-based care
Top tier evidence to guide decision-making
Other reliable sources of information
In closing…
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W
Y
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