Benn Robyn, Rawson Lewis, Phillips Amanda
Circle Integrated Care, 30 Cannon Street, London, EC4M 6XH, UK.
Circle Integrated Care, London, UK.
Ther Adv Musculoskelet Dis. 2023 Jul 29;15:1759720X231187190. doi: 10.1177/1759720X231187190. eCollection 2023.
Knee osteoarthritis (OA) is a chronic, debilitating, musculoskeletal condition that affects millions. The increase in prevalence and its economic impact on healthcare and society raise the need for additional non-surgical interventions.
To assess the referral rates to secondary care consultation and clinical outcomes in patients with severe knee OA treated with a home-based, non-surgical intervention.
This was a retrospective audit on 571 patients with knee OA who met the clinical criteria for total knee replacement (TKR) and received the service between October 2015 and March 2020.
Patients were treated with a non-surgical, home-based, biomechanical intervention that aims to reduce pain and improve function, involving a foot-worn device for gait rehabilitation. The device is adjusted to the patient based on their gait patterns and clinical symptoms. Patients are advised to use the device at home or work and continue their routine. Patients are also advised to return to follow-up appointments to readjust the device and treatment plan. The primary outcome measure was the referral rates to secondary care consultation. Secondary outcomes included patient-reported outcome measures to assess pain and function and a computerised gait test. Follow-up time was between 1 and 6 years post-treatment initiation with a mean follow-up time of 1308.1 (SD = 473.4) days (i.e. 3.5 years.).
There were 65 (11.4%) referrals for secondary consultation with an average follow-up of 3.5 years. The mean days to referral was 480.9 (SD = 399.2) days. Of all referrals, 48% ( = 31) occurred during the first year of treatment, and 32% ( = 21) occurred during the second year. The rest were after more than 2 years of treatment.Significant improvements were seen in all clinical outcomes, including a reduction in pain and an improvement in function and gait patterns ( < 0.05 for all).
Utilising this intervention as a non-surgical option for patients with knee OA who met the clinical criteria for TKR led to a significant reduction in pain and improvement in function after 3 months that was maintained for up to 3 years. Most patients (89%) did not proceed to secondary care consultation during their time in treatment for up to 6 years.
膝关节骨关节炎（OA）是一种慢性、使人衰弱的肌肉骨骼疾病，影响着数百万人。其患病率的上升及其对医疗保健和社会的经济影响，增加了对额外非手术干预措施的需求。
评估接受居家非手术干预治疗的重度膝关节OA患者的二级护理咨询转诊率和临床结果。
这是一项对571例符合全膝关节置换术（TKR）临床标准且在2015年10月至2020年3月期间接受该服务的膝关节OA患者的回顾性审计。
患者接受一种非手术的、居家的生物力学干预，旨在减轻疼痛并改善功能，包括一种用于步态康复的足部穿戴设备。该设备根据患者的步态模式和临床症状进行调整。建议患者在家中或工作时使用该设备，并继续他们的日常活动。还建议患者返回进行随访预约，以重新调整设备和治疗计划。主要结局指标是二级护理咨询的转诊率。次要结局包括患者报告的用于评估疼痛和功能的结局指标以及一项计算机化步态测试。随访时间为治疗开始后的1至6年，平均随访时间为1308.1（标准差=473.4）天（即3.5年）。
有65例（11.4%）患者被转诊进行二级咨询，平均随访3.5年。转诊的平均天数为480.9（标准差=399.2）天。在所有转诊患者中，48%（=31例）发生在治疗的第一年，32%（=21例）发生在第二年。其余的发生在治疗超过2年后。所有临床结局均有显著改善，包括疼痛减轻、功能和步态模式改善（所有P<0.05）。
对于符合TKR临床标准的膝关节OA患者，将这种干预作为一种非手术选择，在3个月后疼痛显著减轻，功能改善，并持续长达3年。在长达6年的治疗期间，大多数患者（89%）未转诊至二级护理咨询。
