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Rheumatology Advance Access published online on October 15, 2007
Rheumatology, doi:10.1093/rheumatology/kem232
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Primary care treatment of knee pain—a survey in older adults

M. Porcheret, K. Jordan, C. Jinks and P. Croft in collaboration with the Primary Care Rheumatology Society

Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Keele, Staffs ST5 5BG, UK

Correspondence to: M. Porcheret, GP Research Fellow, Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Keele, Staffs ST5 5BG, UK. E-mail: m.porcheret{at}keele.ac.uk


  Abstract

Objectives. To describe the treatment of knee pain in older adults in primary care and to compare reported practice with published evidence.

Methods. A semi-structured interview of older adults with knee pain about their use of 26 interventions for knee pain.

Results. 201 adults were interviewed. A median of six interventions had been advised for each participant, with heat and ice (84%) the most frequently advised, followed by paracetamol (71%), compound opioid analgesics (59%) and non-selective non-steroidal anti-inflammatory drugs (59%). Three core treatments for knee pain (written information, exercise and weight loss) were advised to 16%, 46% and 39% of the participants, respectively. Half of the interventions had been initiated through ‘self care’. Most core treatments had not been initiated before second-line interventions had been used, paracetamol being the exception. Referral to surgery was commonly initiated before more conservative options had been tried.

Conclusions. Interventions recommended as core treatment for knee pain in older adults were underused—in particular, exercise, weight loss and the provision of written information. There appeared to be early reliance on pharmacological treatments with underuse of non-pharmacological interventions in early treatment choices. Self care played an important role in the management of this condition. The study provides clear evidence on the need to improve the delivery of core treatments for osteoarthritis and highlights the need to support and encourage self care.

KEY WORDS: Knee pain, Knee osteoarthritis, Treatment, Primary care, Older adults

Submitted 22 March 2007; revised version accepted 2 August 2007.
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