Ebook Care For People With Arthritis: Evidence And Best Practices
This report reviews best practice and evidence-based care for people with arthritis, and looks at both evidence for efficacy (what works) and evidence related to the optimum delivery of interventions (how to apply). This report was originally developed as background information for review of the literature on models of care for arthritis and key informant interviews concerning implementation of novel models of care in Ontario (An Exploration of Comprehensive Interdisciplinary Models for Arthritis, ACREU Working Report 2005-03).
Arthritis and related conditions exact a significant impact on the population of Canada. Arthritis is a leading cause of pain, physical disability and health care utilization. The symptoms of arthritis and related conditions include pain, swelling, or stiffness in or around the joints. If arthritis is not treated appropriately, the disease can affect the structure and function of joints. In turn, this leads to increased pain, disability and difficulty performing activities of daily living. The adverse consequences of arthritis have a significant impact on leisure, and social and labour force participation at all ages.
People living with arthritis, their families and society as a whole are affected by the outcomes of the disease. In 2000, arthritis and related conditions affected nearly 4 million Canadians aged 15 years and older, representing 16% of the Canadian population. In Ontario alone, 1.6 million people have arthritis. The prevalence of arthritis in the population increases with age. However, despite being seen as a disease of the aging, nearly 3 in 5 people who have arthritis are younger than 65 years of age. With the aging of the baby boomers, it is projected that the prevalence of arthritis will increase to 6.4 million Canadians within 25 years. The increased burden of this disease will have a significant impact on health care resources in Canada in the future.
Arthritis is also costly from an economic standpoint. The costs of arthritis have been estimated by Coyte as 6.2 billion Canadian and in a 2003 Health Canada Report as $4.4 billion CDN (1998 dollars). Approximately two-thirds of the costs of arthritis are indirect costs due to disability, a measure of lost productivity.
Arthritis and related conditions comprise a large group of conditions affecting the joints, ligaments, tendons, bones and other components of the musculoskeletal system. The three main categories of arthritis are: a) degenerative arthritis, primarily osteoarthritis (OA), b) inflammatory arthritis such as rheumatoid arthritis (RA), and c) connective tissue and other systemic diseases. OA, a degenerative arthritis, is the most common form of arthritis, characterized by loss of cartilage with concomitant bony changes, including sclerosis and osteophytes . RA is the most common form of inflammatory arthritis. It is a chronic inflammatory polyarthritis, which if untreated or inadequately treated, results in the destruction of the joints and severe functional disability. It may also be accompanied by extracurricular manifestations affecting other organs such as the eyes, heart, and lungs. Connective tissue and other systemic diseases, such as systemic lupus erthematosus, are relatively rare conditions (refer to Appendix A for definitions of the major types of arthritis).
For the purposes of this report, the evidence is reviewed for degenerative arthritis and selected forms of inflammatory arthritis. Most of the research pertains to the most common forms of these diseases, OA and RA, respectively.
Health care services for individuals with inflammatory arthritis and connective tissue/systemic disease are generally provided by specialists. As such, the issues of access to the health care system are similar for these types of arthritis. Early consultation with an arthritis specialist is recommended to confirm diagnosis and treatment of RA. OA can often be managed in a primary care setting with access to specialist care by orthopaedic surgeons when interventions such as total joint replacement (TJR) are considered. Joint replacement is used in those for whom other treatment modalities have failed and who generally have more severe disease. Although the medical management of degenerative arthritis and inflammatory arthritis differ, both share common elements with regard to the management of pain and disability, including non-pharmacologic interventions such as rehabilitation.
Contents
Contributors
Executive Summary
Chapter 1
- 1.1. Overview
1.2 Objectives
1.3 Structure of the Report
1.4 Methods
1.4.1 Literature Search Strategy
1.4.2 Study Selection and Methods of Review
1.5 Results of the Literature Review
Chapter 2. Primary Prevention
- 2.1 Introduction
2.2 Results
2.2.1 Model of Risk Factors Associated with Arthritis
2.2.2 Systemic Factors
2.2.3 Intrinsic Joint Vulnerability
2.2.4 Extrinsic Factors
2.3 Results: Rheumatoid Arthritis
2.3.1 Systemic Factors
2.3.2 Extrinsic Factors
2.4 Prevention Approaches
2.4.1 Osteoarthritis
2.4.2 Rheumatoid Arthritis
2.4.3 Other Forms of Arthritis
Chapter 3. Pharmacologic Treatments for Osteoarthritis and Rheumatoid Arthritis
- 3.1 Introduction
3.2 Results
3.2.1 The Use of Pharmacologic Agents in the Treatment of OA
3.2.1.1 Complementary and Alternative Medicine
3.2.1.2 Analgesics
3.2.1.3 Corticosteroids
3.2.1.4 Hyaluronan Acid
3.2.1.5 Non-Steroidal Anti-Inflammatory Drugs
3.2.1.6 Disease Modifying Anti-Rheumatic Drugs
3.2.2 The Benefits of Pharmacologic Agents in the Treatment of RA
3.2.2.1 Disease Modifying Anti-Rheumatic Drugs
3.2.2.2 Biologic Response Modifiers
3.2.2.3 Non-Steroidal Anti-Inflammatory Drugs
3.2.2.4 Corticosteroids
3.2.2.5 Analgesics
3.2.2.6 Vitamin and Mineral Supplements
3.2.2.7 Complementary and Alternative Medicine
3.2.3 Delivery of Care for the Pharmacologic Management of Osteoarthritis and Rheumatoid Arthritis
3.2.3.1 Barriers to Adequate Pharmacologic Care
3.2.3.2 Evaluation of Models of Care for Pharmacology
3.3 Discussion
3.3.1 Pharmacologic Management of OA
3.3.2 Pharmacologic Management of RA
Chapter 4. Non-Pharmacologic and Rehabilitation Best Practices in the Management of Arthritis
- 4.1 Introduction
4.2 Results
4.2.1 Education
4.2.1.1 Effectiveness of Education
4.2.1.2 Delivery of Educational Interventions
4.2.2 Exercise
4.2.2.1 Physical, Functional, Physiological, and Behavioral Effects
4.2.2.2 Exercise and Specific Joints
4.2.2.3 Parameters of Exercise
4.2.2.4 Delivery of Exercise Programs
4.2.2.5 Individualized Versus Class-Based Exercise Programs
4.2.3 Rehabilitation Modalities
4.2.3.1 Evidence of Effectiveness
4.2.4 Joint Protection
4.2.4.1 Evidence of Benefit
4.2.4.2 Delivery of Joint Protection
4.2.5 Assistive Devices
4.2.6 Orthoses
4.2.7 Vocational Rehabilitation
Chapter 5. Arthritis Self-Management Strategies
- 5.1 Introduction
5.2 Results
5.2.1 Self-Management Content
5.2.2 Evidence of Effectiveness
5.2.2.1 Patient Outcomes
5.2.2.2 Long-Term Benefits
5.2.2.3 Cost Savings
5.2.3 Delivery of Self-Management Programs
5.2.3.1 Role of Health Care Provider/ Patient Collaboration in Delivery of Programs
5.2.3.2 Target Population and Access
5.3 Discussion
Chapter 6. Rehabilitation Best Practices in the Management of Total Joint
Replacement
- 6.1 Introduction
6.2 Results: Pre-Operative Rehabilitation
6.2.1 Effectiveness of Pre-Operative Education
6.2.2 Delivery of Pre-Operative Education
6.2.3 Evidence of Effectiveness of Pre-Operative Exercise
6.3 Results: Pre-Operative Rehabilitation
6.3.1 Evidence of Effectiveness of Exercise
6.3.1.1 Exercise Following Total Knee Replacement
6.3.1.2 Exercise Following Total Hip Replacement
6.3.2 Evidence of Effectiveness of Continuous Passive Motion
6.3.3 Delivery of Post-Operative Rehabilitation
6.3.3.1 Timing of Therapy
6.3.3.2 Intensity of Therapy
6.3.3.3 Post-Operative Rehabilitation Settings
6.3.3.4 Determinants of Inpatient Rehabilitation
6.4 Summary
Chapter 7. Access To Orthopaedic Services for Arthritis
- 7.1 Introduction
7.2 Results
7.2.1 Access to Orthopaedic Services
7.2.2 Access to Total Joint Replacement
7.2.2.1 Utilization Rates
7.2.2.2 Management of Waiting Lists
7.2.2.3 Measurement of Wait Times
7.2.2.4 Prioritization for TJR
7.2.2.5 Patients’ Perspectives of Waiting Lists
7.2.2.6 Effect of Wait Times on Outcomes
7.2.3 Arthroscopic Surgery for OA of the Knee
7.2.3.1 Effectiveness of Arthroscopic Procedures
7.2.3.2 Indications for Arthroscopic Procedures
7.2.3.3 Utilization Rates for Arthroscopy
7.3 Summary
Reference List
- Appendix A: Major Types of Arthritis
Appendix B: Search Strategy
Appendix C: Pharmacologic Agents
Appendix D: Evidence for Pharmacology
Appendix E: Results of Rehabilitation Literature Search
Appendix F: Self-Management Activities and Skills
Appendix G: Self-Management Literature Summary
Table 1.1: Literature Review Summary
Table 3.1: Osteoarthritis: Conclusive Evidence by Type, First Author and Publication Year
Table 3.2: Rheumatoid Arthritis: Conclusive Evidence by Type and Publication Year
Table 4.1: Literature Summary for Individual-Intervention Level Studies
Table: 7.1: International Comparison of Crude Rates (per 100,000 population) of Primary TKR and THR
Table 7.2: Indications for Surgery
Figure 2.1: Risk Factors Associated with Arthritis
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