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Exercise position statement for implementation of therapeutic exercise for people with knee and hip osteoarthritis
Study Taskforce: Dr. Melanie Holden, Dr. Kate Button, Dr. Natalie Collins, Dr. Elizabeth Cottrell, Prof Yves Henrotin, Prof Kim Bennell, Prof Rana Hinman, Jesper Bie Larsen, Mr. Ben Metcalf, Dr. Hiral Master, Dr. Soren Thorgaard Skou, Dr. Louise Thoma, Dr. Elizabeth Wellsandt, Dr. Daniel White, and Dr. Belinda Lawford
Aim of the study: to develop evidence-informed position statements and practical resources for the implementation of therapeutic exercise for individuals with knee and hip osteoarthritis using an international multi-disciplinary consensus process.
Stage 1: Evidence synthesis
The narrative review has been published: https://pubmed.ncbi.nlm.nih.gov/32860729/
Stage 2: Statement generation
239 people formed our international panel of experts and provided at least one proposition statement. Of the experts, 106 (44.3%) were clinical academics/academic researchers, 97 (40.6%) were healthcare professionals or exercise providers spanning at least 10 disciplines, and 36 (15.1%) were consumer representatives. Panel members resided in 25 different countries, most commonly Australia (n=53 (22.2%)) and the United Kingdom (n=29 (12.1%)). 504 statements were generated, which were sorted and condensed for Stage 3 of the study.
Stage 3: Consensus via Delphi technique
3 Delphi rounds were completed. The final recommendations comprised of 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) complete a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualize exercise; 9) optimize the delivery of exercise; 10) focus on exercise adherence; 11) provide education about OA and the role of exercise.
Conclusions: Our evidence-informed recommendations provide the most detailed guidance to date on how to implement best practice therapeutic exercise for people with knee and/or hip OA. These recommendations have the potential to optimize exercise delivery within clinical practice, and thus improve outcomes for people with knee and/or hip OA.
The Discussion Group ECR sub-group is being led by Jesper Bie Larsen and Dr. Hiral Master, with members including Dr. Belinda Lawford, Dr. Patrick Corrigan, Dr. Cecilie Roedgaard Bartholdy, Elisabeth Ginnerup, Anthony Teoli, and Christine Le.
The ECR sub-group is currently leading a study to develop an online “toolbox” containing a suite of practical resources to facilitate the implementation of the exercise. This will involve using data collected from stage 2 of the exercise position study above to inform what type of resources would be most useful for patients and clinicians. The study protocol is currently being developed and data analysis is underway.