Article Text

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis
  1. Linda Fernandes1,
  2. Kåre B Hagen1,
  3. Johannes W J Bijlsma2,
  4. Oyvor Andreassen3,
  5. Pia Christensen4,5,
  6. Philip G Conaghan6,
  7. Michael Doherty7,
  8. Rinie Geenen8,
  9. Alison Hammond9,
  10. Ingvild Kjeken1,
  11. L Stefan Lohmander10,11,12,
  12. Hans Lund11,
  13. Christian D Mallen13,
  14. Tiziana Nava14,
  15. Susan Oliver15,
  16. Karel Pavelka16,
  17. Irene Pitsillidou17,
  18. José Antonio da Silva18,
  19. Jenny de la Torre19,
  20. Gustavo Zanoli20,
  21. Theodora P M Vliet Vlieland21
  1. 1National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Department of Rheumatology, Patient Panel, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Department of Rheumatology, The Parker Institute, Copenhagen University Hospital at Fredriksberg, Copenhagen, Denmark
  5. 5Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
  6. 6Division of Musculoskeletal Disease, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  7. 7Academic Rheumatology, University of Nottingham, Nottingham, UK
  8. 8Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
  9. 9Centre for Health Sciences Research, University of Salford, Salford, UK
  10. 10Department of Orthopaedics, Clinical Sciences Lund, University of Lund, Lund, Sweden
  11. 11Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  12. 12Department of Orthopaedics and Traumatology, University of Southern Denmark, Odense, Denmark
  13. 13Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  14. 14Faculty of Physiotherapy, University of Studies of Milan, Milan, Italy
  15. 15Nurse Consultant Rheumatology, Minerva Health Centre, Preston, UK
  16. 16Institute of Rheumatology and Clinic of Rheumatology, First Medical Faculty, Charles University, Prague, Czech Republic
  17. 17Cyprus League Against Rheumatism, Cyprus, Cyprus
  18. 18Department of Rheumatology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
  19. 19Rheumatology Department, Alicante General and University Hospital, Alicante, Spain
  20. 20Università degli Studi di Ferrara Casa di Cura SM Maddalena, Ferrara, Italy
  21. 21Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Linda Fernandes, National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Postboks 23, Vinderen, Oslo 0319, Norway; linda.fernandes1{at}


The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I–IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.

  • Osteoarthritis
  • Nursing
  • Occupational therapy
  • Physcial therapy
  • Psychology

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