Article Text

PDF
SP0177 Management of Secondary Care as Support for Primary Care for People with Hip or Knee Osteoarthritis: The AMS-OA Cohort Study.
  1. M. Van Der Esch1
  1. 1Amsterdam Rehabilitation Research Institute, Reade, Center for Rehabilitation and Rheumatology, Amsterdam, Netherlands

Abstract

Introduction Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, the Netherlands, started an outpatient clinic for people with knee and/or hip osteoarthritis (OA) in 2009. The main reason behind this is that OA is a heterogeneous disease with different presentations, and as a consequence requires a variety in care options. Knee and/or hip OA is a common condition managed frequently in primary care, but often not in line with national and international guidelines. The ideal consultation for a patient with knee and/or hip OA is not known, but in general, non-complex patients are supposed to be treated in primary care and complex patients in secondary care. Protocols have been established for the diagnosis and treatment of knee and/or hip OA by rheumatologists and specialists in rehabilitation medicine, incorporating medical and functional assessments. Results from assessments provide guidance to referrals in primary of secondary care, whereby data from assessments can be used for scientific research.

Method The outpatient clinic consists of patients aged 18 years or older with symptoms of the knee and/or hip indicative of OA. The initial step in the diagnostic care-process is to exclude other diseases and to diagnose knee and/or hip OA in accordance with the ACR criteria and supplementary radiology criteria. Limitations in daily activities and several psychosocial and biomechanical variables are assessed. Inclusion criteria for secondary care are disease complexity such as co morbidity, high pain intensity and/or many activity limitations or insufficient treatment results from primary care.

Results Since February 2009, a total of 500 patients have been included. Most of these patients have a Kellgren & Lawrence score of 2 or more, indicative of mild-to-severe cartilage degeneration. These patients show mild to severe activity limitations with a mean WOMAC score for functioning of 26.9 ±121.9 (range 0-69) and moderate pain with a NRS (during the last week) of 5.2 ±2.2 (range 0-10). In general, most patients show muscle weakness. The OA management in secondary care has been improved; referrals for primary care are more adequate but need to be improved. Results form several studies from the AMS-OA data have been used to improve the assessments and the therapeutically applications

Conclusions Results show that the population of knee and/or hip patients referred to our outpatient clinic is heterogeneous. The assessments of activity limitations and the determinants behind these limiting factors are important in distinguishing between complex and non-complex knee and/or hip OA patients, guide adequate referrals and further research.

Disclosure of Interest None Declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.