Journal
SEMINARS IN ARTHRITIS AND RHEUMATISM
Volume 51, Issue 4, Pages 749-760Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.semarthrit.2021.04.017
Keywords
Osteoarthritis; Flare; Pain exacerbation; Management; Clinical care
Categories
Funding
- National Health and Medical Research Council (NHMRC) Investigator Grant
- National Institute for Health Research (NIHR) In-Practice Fellowship [IPF-2014-08-03]
- NIHR Academic Clinical Fellowship
- NIHR School for Primary Care Research Progression Fellowship
- Integrated Clinical Academic Programme Clinical Lectureship from the NIHR
- Health Education England (HEE) [ICA-CL-2016-02-014]
- NIHR Development and Skills Enhancement Award [NIHR300818]
- National Institutes of Health Research (NIHR) [NIHR300818] Funding Source: National Institutes of Health Research (NIHR)
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There is currently a lack of evidence on non-pharmacological treatments for managing OA flares, with no robust evidence to support or reject any specific therapies in clinical practice. Future research is needed to explore outcomes beyond pain, trajectories of symptom improvement, and management strategies for joints other than the knee.
Introduction: Transient episodes of increased pain, stiffness or swelling are common in people with osteoarthritis (OA). Yet, evidence-based management strategies for lessening the impact of OA flares are rarely covered in clinical guidelines and have been identified as a gap by clinicians delivering OA care. We aimed to identify evidence on behavioral, lifestyle or other adjunctive flare management strategies that could be used by clinicians or consumers. Materials and methods: A literature search between 1990-2020 was performed in three databases using a scoping methodology. We included qualitative or quantitative studies, and reviews that examined OA flare management, or that reported OA flare outcomes at timepoints <2 weeks post-intervention. Outcomes included any physical or psychological OA outcome treatable with a therapeutic intervention. Results: We included 9 studies, all of which examined the relationship between therapeutic exercise/ physical activity and OA flares. All studies reported pain outcomes at the knee. Two also included the hip. Only two studies examined specific management strategies for OA flares. Both favorably reported the benefits of undertaking an exercise program modified accordingly during an episode, but the quality of the evidence was low. Discussion: This scoping review highlights the paucity of evidence available on non-pharmacological treatments of OA flare management that could influence clinical practice. At present, there is no robust evidence to support or reject any specific therapies for OA flare management in clinical practice. Future work is needed, particularly around outcomes beyond pain, trajectories of symptom improvement, and for joints other than the knee. (c) 2021 Elsevier Inc. All rights reserved.
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