Patient discussions
Consider referring the patient for physiotherapy, bearing in mind that objectively significant improvement has only been noted with lumbosacral flexion.[58] Consider referring the patient for occupational therapy if appropriate: for example, if the patient is in manual labour employment.[4]
Discuss implications of associated metabolic derangements, such as obesity, hyperlipidaemia, hypertension, and hyperglycaemia, as relevant to the patient: for example, in symptom control and disease progression.
Advise the patient to incorporate joint protection principles, such as avoiding activities that do not allow for a change in position, respecting pain, and avoiding actions that may lead to joint deformity. Also consider discussion of fracture and falls prevention measures as needed. This may include the benefits of weight-bearing, balance and strength training exercises and activity, smoking cessation, and avoiding or limiting alcohol use.
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