Edito of 02/03/2015
Physical activity is a major component of the treatment of osteoarthritis. It is strongly recommended by all therapists. Two recent publications noted that these recommendations were followed very irregularly and only by a “low to moderate” proportion of patients. How to improve this?
The general review published in 2012 explored the relationship between osteoarthritis of the knee and physical activity. It observed that in spite of considerable encouragement to practice a physical activity to limit the progression of the disease, the compliance of this activity remains low. The barrier made up by the co-morbidities participates to this low level.
The meta-analysis of 2013 concerns osteoarthritis of the knee (21 studies) and osteoarthritis of the hip (11 studies). It analyses 3 types of physical exercises: moderate to strong intensity physical activity, the same activity (but split) and that which consists in taking a minimum number of steps during the day.
This meta-analysis found a “low to moderate” proportion of patients who complied with the recommendations concerning exercise.
Whether it concerns taking medicines or the “move more” advice associated with a change in dietary habits, medication adherence (which is a better term than compliance) is influenced by the same factors. They should be taken into account by the practitioners during prescription and during the monitoring of the treatment, as it is the best way to obtain a good adherence of the patient to his/her treatment.
Listening to the patient concerning what his/her expectations are, his/her understanding of the risks related to the disease and his/her commitment capacity in a therapeutic process is the first part of taking it into account. Providing all the information required is the second. This means taking time necessary to “get the message through” on the therapeutic issues. Finally, adherence must remain at the centre of the concerns of the caregiver during the monitoring of the treatment. Questions concerning the “well-being felt” or conversely on the unpleasant effects allow reopening the dialogue and the reminder of pertinent information. In this context, accompanying the treatment of the patient via a personalised global “coaching” programme on the Web and/or with the assistance of the physical therapist is an opportunity that must be seized.
This editorial refers to 3 recent articles posted on the Web in their entirety.
Schneider MP, Herzig L, Hampai DH, Bugnon O.
[Medication adherence in chronic patients: from its concepts to its management in primary care].
Rev Med Suisse.2013 May 15;9(386):1032-6.
Knee osteoarthritis and exercise adherence: a review.
Curr Aging Sci.2012 Feb;5(1):72-83.
Wallis JA, Webster KE, Levinger P, Taylor NF.
What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis.
Osteoarthritis Cartilage. 2013 Nov;21(11):1648-59.
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