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Recommendation
EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update
  1. Tuva Moseng1,
  2. Theodora P M Vliet Vlieland2,
  3. Simone Battista3,
  4. David Beckwée4,
  5. Vladimira Boyadzhieva5,
  6. Philip G Conaghan6,
  7. Daniela Costa7,
  8. Michael Doherty8,
  9. Andrew G Finney9,10,
  10. Tsvetoslav Georgiev11,
  11. Milena Gobbo12,
  12. Norelee Kennedy13,
  13. Ingvild Kjeken1,
  14. Féline P B Kroon14,15,
  15. L Stefan Lohmander16,
  16. Hans Lund17,
  17. Christian D Mallen18,
  18. Karel Pavelka19,
  19. Irene A Pitsillidou20,
  20. Margaret P Rayman21,
  21. Anne Therese Tveter1,
  22. Johanna E Vriezekolk22,
  23. Dieter Wiek23,
  24. Gustavo Zanoli24,
  25. Nina Østerås1
  1. 1Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Leiden, Netherlands
  3. 3University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health, Genova, Italy
  4. 4Rehabilitation Research Department, Vrije Universiteit Brussel, Brussel, Belgium
  5. 5UMHAT “St. Iv. Rilski” Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria
  6. 6Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomechanical Reserch Centre, Leeds, UK
  7. 7Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
  8. 8Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
  9. 9Research Institute for Primary Care and Health Sciences, Keele University School of Medicine, Keele, UK
  10. 10School of Nursing and Midwifery, Keele University, Keele, UK
  11. 11Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine, Medical University Varna, Varna, Bulgaria
  12. 12Positivamente Centro de Psicología, Madrid, Spain
  13. 13School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
  14. 14Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  15. 15Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
  16. 16Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
  17. 17Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
  18. 18Keele University School of Medicine, Keele, UK
  19. 19Institute of Rheumatology, Department of Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
  20. 20EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
  21. 21Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
  22. 22Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands
  23. 23EULAR Patient Research Partner, Deutsche Rheuma-Liga, Bonn, Germany
  24. 24Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Novara, Italy
  1. Correspondence to Dr Tuva Moseng; tuva.moseng{at}diakonsyk.no

Abstract

Introduction Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.

Methods The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.

Results The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0–10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.

Conclusions The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

  • Osteoarthritis, Knee
  • Osteoarthritis
  • Rehabilitation
  • Physical Therapy Modalities
  • Therapeutics
http://creativecommons.org/licenses/by-nc-nd/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). See:http://creativecommons.org/licenses/by-nc-nd/4.0/.

https://doi.org/10.1136/ard-2023-225041

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    Footnotes

    • Handling editor Josef S Smolen

    • X @DrS_Battista

    • Contributors TM was the research fellow for the project, undertaking the SLR in cooperation with NØ. The fellow was supervised by the steering group consisting of NØ (convenor) and TPMVV (methodologist). NØ and TPMVV supervised the process of the SLR. NØ organised and chaired the TF meetings. TM drafted the manuscript with advice from NØ and TPMVV. All authors have contributed to the recommendations by participating in the TF meetings; during discussion and agreement on the recommendations; revising and approving the manuscript for publication.

    • Funding This study was funded by European League Against Rheumatism (HPR055).

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests TPMVV was the Vice president EULAR health professionals 2020–2022 and is part of the EULAR Advocacy Committee 2020–present. MG holds a leadership position in OpenReuma/Spanish Association of Health Professionals in Rheumatology (unpaid). CDM received Grants from Versus Arthritis, MRC, NIHR (paid to Keele University) and is the director of the NIHR School for Primary Care Research. SL received payment as scientific consultant from Arthro Therapeutics AB and received payment from AstraZeneca as a member of DSMB. DC received grants from Fundação para a Ciência e Tecnologia SFRH/BD/148420/2019 and Pfizer (ID 64165707). GZ received payment for expert testimony from Casa di Cura San Francesco, Verona and Support for attending meetings and/or travel from Orthotech and Jtech, payment for participation on a Data Safety Monitoring Board or Advisory Board from VIVENKO for Gruenenthal and Ethos for Angelini and holds other financial interests related to clinical practice as an orthopedic surgeon (performing total joint replacement, arthroscopies and other types of surgeries), either directly from private patients or indirectly from the health system or insurances acting as a private consultant. JEV has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly Netherlands BV. TG has received paid honoraria for lectures by Abbvie, Novartis, Boehringer Ingelheim, UCB, Berlin-Chemie/A. Menarini Bulgaria, Sandoz and received support for attending meetings by Abbvie, Pfizer and UCB. DW is an International Advisory Board Member of DRFZ (Germany) 2019–current and was the EULAR PARE Chair 2015–2017and an EULAR Vice President representing PARE 2017–2021.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.