Missing pain-management step for hip and knee replacement patients addressed

University of Alberta researchers say 50 per cent of arthritis patients aren’t ready for hip or knee replacement surgery. Allyson Jones and Lauren Beaupre, professors in the Faculty of Rehabilitation Medicine, believe these patients can be better managed with physical therapy until surgery is required.

"We know that physical therapy works for people with arthritis; there’s good evidence that exercise, lifestyle management and education can really help people live better with arthritis," said Beaupre.

Currently, orthopaedic surgeons decide if a patient is ready for surgery, but Jones and Beaupre say patients could be assessed by a triage physical therapist first, who could determine whether or not a patient should be referred to a surgeon.

"If they have severe arthritis, exercise isn’t going to work and they can be referred on to surgery, but if they have mild to moderate arthritis – where they might have a lot of pain, but their joint hasn’t reached the end stage of the disease – that’s when physio can step in," said Beaupre.

The researchers say this would allow the therapist to not only help with pain management and function, but also free up some of the surgeon’s time.

"It’s a better use of the resources; it may shorten the wait times because we know those who are on the wait list are going to be seen by orthopaedic surgeons and those who don’t need to be on the surgical wait list are still being seen and still being managed," added Beaupre.

The researchers say this method of triaging is done in Ontario, the United Kingdom, Australia and New Zealand.

Jones and Beaupre are starting the conversation about this process through a blog and Rehab Dialogue, a series of interactive articles inviting government, health-care professionals and the community to discuss how rehabilitation could or should play a greater role in the health-care system.

Edmontonian Debra Ward, who has osteoarthritis and rheumatoid arthritis, and whose mother suffered from severe arthritis, is encouraged by Jones’ and Beaupre’s work.

"I believe that involving physical therapists to help people manage their arthritis pain through exercise, activity and education is a huge leap forward for arthritis sufferers," said Ward.

Ward says the blog and Rehab Dialogue information brochures are vital in the exchange of information.

"Researchers, arthritis patients and any interested parties can connect, share ideas and stories. This is a winning strategy for everyone."

Jones and Beaupre are also currently working on a study on how "prehabilitation" – rehabilitation before surgery – benefits arthritis patients waiting for replacement surgery.

"We are looking at people who do exercise before their surgery to see if it influences their recovery as compared to usual care," said Jones.

(Source: University of Alberta: Rehab Dialogue: July 2010)