PARIS – Use of conservative, nonpharmacologic osteoarthritis therapies was relatively low and varied considerably across 10 primary care clinics within the same U.S. health care system.
In seven of the clinics, for example, less than half of patients had ever received physical therapy for knee osteoarthritis, with a range of 24%-61%.
Physical therapy for hip OA was even less common, ranging from 0%-71%, Kelli D. Allen, Ph.D., reported at the World Congress on Osteoarthritis.
In contrast, 70%-88% of patients were currently using pain medications such as opioids or NSAIDs to treat their symptomatic hip and/or knee OA, according to the cross-sectional analysis.
Patients received care at 1 of 10 family and internal medicine Duke Primary Care clinics in North Carolina. All were overweight and not meeting physical activity recommendations. Patients had OA symptoms for an average of 10 years, their average WOMAC (Western Ontario and McMaster Osteoarthritis Index) score was 39, and average age was 63 years.
Four of the clinics were in a rural setting (population less than 20,000), one in a medium-size town (20,000-99,999), four in small cities (100,000-250,000), and one in a large city (more than 250,000). The clinics had an average of 6.4 physicians and one nurse practitioner or physician’s assistant.
Knee brace use of any type ranged from 40%-64% across clinics, Dr. Allen reported. Use of knee braces with metal supports was even lower at 0%-18%.
The relatively low use of PT and knee braces with metal supports "may signal a need for more specific treatment recommendations or guidance for consistent application," suggested Dr. Allen, a health services researcher and exercise physiologist, Duke University Medical Center and Durham VA Medical Center, both in Durham, N.C.
Knee injections were reported by 43%-70% of patients.
Intraclass correlation coefficients (ICCs) were calculated to measure between-clinic variation in treatment use, with an ICC of more than .01 indicating considerable variation.
ICCs were 0.01 for the proportion using any pain medications, 0 for opioids, NSAIDS, knee injections and knee braces, 0.02 for metal knee braces, 0.07 for knee PT, and 0.08 for hip PT, according to Dr. Allen.
Rural clinics were typically below the median for nonpharmacologic use, possibly because of fewer resources in these areas, according to the poster presentation.
Clinics with fewer patients reporting "fair" or "poor" general health, however, tended to have higher use across treatment categories.
"These OA therapies may be more highly utilized when patients have fewer competing health problems," she suggested at the meeting, sponsored by the Osteoarthritis Research Society International.
Overall, 20% of patients in the study reported having fair or poor health, but rates ranged from a low of 10% to a high of 35%.
The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Allen reported no conflicts of interest.