- \n
- Adjunct Treatments are used to improve the individual\u2019s ability to fully participate in the Core Treatments<\/li>\n
- The costs of Adjunct Treatments should be discussed before adding a treatment to a care plan<\/li>\n<\/ul>\n\nNon-pharmacological Treatments<\/div>\n<\/div>\n
- \n
- Supports can improve stability and mobilization, conserve energy, minimize the risk of falling and provide options for safe movement to reduce the lower limb loading that can increase pain<\/li>\n
- The individual\u2019s pain experience can be influenced by changes in physical, emotional, behavioural, and cognitive states so cognitive behaviour therapy can be offered that may or may not include Acceptance Commitment Therapy (ACT) and mindfulness<\/li>\n
- Inter-disciplinary self-management programs offer more specific resources and strategies to help struggling individuals develop coping skills in response to their evolving symptoms<\/li>\n<\/ul>\n\nPharmacological Treatments<\/div>\n<\/div>\n
- \n
- The algorithm guides progressive use of pharmacological treatments<\/li>\n
- The individual\u2019s full history should be considered before prescribing<\/li>\n
- Complications, side effects and possible interactions of medications should be considered<\/li>\n
- Intra-articular injections includes: steroids, hyaluronic acid and platelet rich plasma<\/li>\n
- Advanced pain management includes opioids (use with extreme caution), peripheral nerve blocks or referral for joint surgery<\/li>\n<\/ul>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_text_color=”#000000″ text_font_size=”18px” background_color=”#f2f2f2″ custom_padding=”20px|20px|20px|20px|true|true” border_radii=”on|20px|20px|20px|20px” global_colors_info=”{}”]<\/p>\n
KEY RESOURCES<\/strong><\/span><\/span><\/h3>\n
- \n
- Canadian Opioid Prescribing Guidelines <\/a>
\n<\/span><\/li>\n- Arthritis Society Website on Medical Cannabis Use <\/a>
\n<\/span><\/li>\n- Bone and Joint Health SCN White Paper on Stem Cells <\/a>
\n<\/span><\/li>\n- Shared Decision-Making Toolkit <\/a>
\n<\/span><\/li>\n- FORM to Document\/Modify a Care Plan for Management of OA <\/a>
\n<\/span><\/li>\n- Tables of Examples for the Treatment Toolbox <\/a>
\n<\/span><\/li>\n- PEER OA Decision Aid <\/a>
\n<\/span><\/li>\n- Health Change Methodology <\/a>
\n<\/span><\/li>\n- Alberta Referral Directory<\/a>
\n<\/span><\/li>\n<\/ul>\nView All Resources<\/strong><\/a><\/p>\n
View References<\/strong><\/a>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ module_class=”desk” _builder_version=”4.16″ _module_preset=”default” background_color=”rgba(255,255,255,0.86)” background_image=”https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/Pngtree\u2014blue-hexagon-abstract-medical-technology_1298247-e1653654071890.jpg” background_size=”initial” background_position=”top_left” background_blend=”overlay” custom_margin=”||||false|true” custom_padding=”||100px||false|true” global_colors_info=”{}”][et_pb_row column_structure=”1_4,3_4″ _builder_version=”4.18.0″ _module_preset=”d55fc8c6-b5de-4b77-a65b-80d125d2b382″ global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.18.0″ _module_preset=”e067a3d0-44a1-4396-9c39-e633c5db2c25″ background_color=”rgba(255,255,255,0.64)” z_index=”1″ global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Introduction<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Walking & environmental supports<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Cognitive behavioural therapy<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Self management<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Pharmacological interventions<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Prescribing adjunct treatments<\/a>[\/et_pb_text][\/et_pb_column][et_pb_column type=”3_4″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”||||false|false” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
\nINTRODUCTION<\/h1>\n
\nCore Treatments (Standard 4<\/a>, Standard 5<\/a>, and Standard 6<\/a>) are essential foundations of every care plan and have the strongest evidence for conservative management of osteoarthritis (OA)1-4<\/sup><\/a>.<\/strong> However, Adjunct Treatments can be considered if individuals with OA:<\/p>\n
\n1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.<\/p>\n
2<\/sup>Gay C, Chabaud A, Guilley E, Coudeyre E. Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. Annals of Physical and Rehabilitation Medicine. 2016;59(3):174-83.<\/p>\n
3<\/sup>Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best evidence rehabilitation for chronic pain part 5: Osteoarthritis. Journal of Clinical Medicine. 2019;8(11):1769.<\/p>\n
4<\/sup>Wellsandt E, Golightly Y.\u202fExercise in the management of knee and hip osteoarthritis. Current Opinion in Rheumatology. 2018;30(2):151-9.<\/p>\n<\/div>\n<\/div>\n
- \n
- Find it difficult to participate in Core Treatments<\/li>\n
- Report minimal progression toward their goals or<\/li>\n
- Require additional support to manage symptoms<\/li>\n<\/ul>\n
Adjunct Treatments are used to improve the individual\u2019s ability to fully participate in Core Treatments.<\/strong> The clinician can provide evidence informed non-pharmacological and pharmacological treatments options to support the individual\u2019s goals. In particular, muscle weakness, joint pain and fear of exacerbating symptoms can be barriers to adhering with prescribed exercise and physical activity (Standard 5<\/a>). Addressing these physical and emotional barriers with Adjunct Treatments can support:<\/p>\n
- \n
- Affected joints to ease mobility5<\/sup>5<\/sup>Yu SP, Hunter DJ. Managing osteoarthritis. Australian Prescriber. 2015;38(4):115-9. <\/span><\/span><\/li>\n
- Behavioural change1<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.<\/span><\/span><\/li>\n
- Long-term commitment to exercise and physical activity1<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.<\/span><\/span><\/li>\n<\/ul>\n
The clinician may refer to other disciplines with additional skills in OA management<\/a> and expertise in specific Adjunct Treatments to build and strengthen the individual\u2019s support network. This multidisciplinary care team approach combined with collaboration with the individual will ensure the individual\u2019s priorities, values and preferences are considered when pursuing Adjunct Treatments. Any additional costs of Adjunct Treatments should be considered and discussed with the individual before adding to an OA care plan.<\/strong><\/p>\n<\/div>\n
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\nWALKING & ENVIRONMENTAL SUPPORTS<\/h1>\n
Non-pharmacological Adjunct Treatments include any non-medicinal intervention proven to support symptom management. They are:<\/p>\n
- \n
- Supports (walking and environmental)1,5<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.
\n5<\/sup>Yu SP, Hunter DJ. Managing osteoarthritis. Australian Prescriber. 2015;38(4):115-9. <\/span><\/span><\/li>\n- Cognitive behavioural therapy1<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.\/span><\/span><\/span><\/li>\n
- Inter-disciplinary self-management programs1<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.<\/span><\/span><\/li>\n<\/ul>\n
The use of walking supports can improve stability, mobilization, minimize the risk of falling and the severity of injury if a fall does occur, and reduce the lower limb loading that can increase pain. Walking supports include:<\/p>\n
- Cognitive behavioural therapy1<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.\/span><\/span><\/span><\/li>\n
- Behavioural change1<\/sup>1<\/sup>Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.<\/span><\/span><\/li>\n
- Affected joints to ease mobility5<\/sup>5<\/sup>Yu SP, Hunter DJ. Managing osteoarthritis. Australian Prescriber. 2015;38(4):115-9. <\/span><\/span><\/li>\n
- Arthritis Society Website on Medical Cannabis Use <\/a>
- Canadian Opioid Prescribing Guidelines <\/a>
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<\/p>\n