Patients use fewer analgesics following supervised exercise therapy and patient education: an observational study of 16 499 patients with knee or hip osteoarthritis.

Abstract

OBJECTIVES:

To investigate changes in analgesic use before and after supervised exercise therapy and patient education in patients with knee or hip osteoarthritis (OA).

METHODS:

We recruited 16 499 of 25 933 eligible patients (64%; mean age 64.9; SD 9.6; 73% women) from the Good Life with osteoArthritis in Denmark (GLA:D) registry. Change in proportions of analgesic users (categorised according to analgesic risk profile; opioids > non-steroidal anti-inflammatory drugs > paracetamol) was assessed from before to after an 8-week supervised exercise therapy and patient education programme targeting knee or hip OA pain and functional limitations.

RESULTS:

Patients reported 13.2 mm (95% CI 12.8 to 13.6) less pain (visual analogue scale 0-100 mm) at follow-up compared with baseline. The proportion of analgesic users reduced from 62.2% (95% CI 61.5 to 63.0) at baseline to 44.1% (95% CI 43.3 to 44.9) at follow-up (absolute change: 18.1% (95% CI 17.3 to 19.0)). Among patients using analgesics at baseline, 52% changed to a lower risk analgesic or discontinued analgesic use. The proportion of opioid users after the exercise therapy was 2.5% (95% CI 2.1 to 2.9) lower than baseline; this represents a relative reduction of 36%.

CONCLUSION:

Among patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.

• Authors: Jonas Bloch Thorlund, Ewa M Roos, Patricia Goro, Emily Gromelsky Ljungcrantz, Dorte Thalund Grønne, Søren T Skou
• Journal: British journal of sports medicine (Br J Sports Med) Vol. 55 Issue 12 Pg. 670-675 (Jun 2021) ISSN: 1473-0480 [Electronic] England
• PMID: 32958468 (Publication Type: Journal Article, Observational Study)
• Copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Analgesics
• Analgesics, Opioid
• Anti-Inflammatory Agents, Non-Steroidal
• Acetaminophen

Topics

• Acetaminophen (administration & dosage)
• Aged
• Analgesics (administration & dosage)
• Analgesics, Opioid (administration & dosage)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage)
• Confidence Intervals
• Denmark
• Directly Observed Therapy
• Exercise Therapy (methods)
• Female
• Humans
• Male
• Middle Aged
• Osteoarthritis, Hip (diagnosis, drug therapy, rehabilitation)
• Osteoarthritis, Knee (diagnosis, drug therapy, rehabilitation)
• Patient Education as Topic
• Registries