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CNSLF Med - Osteoarthritis (ii) (Occupational tx (can improve function,…
CNSLF Med - Osteoarthritis (ii)
Other tx
no proven disease modifying agents - all drugs are for symptom management only
intra articular hyaluronic acid derivatives can have trophic effect on cart - 3-4 injections (knees + shoulders easy to inject)
intra articular depot corticosteroids effectives but for short term only
Physical pain management
hot + cold packs, hot water
evidence for other physiotx is weak but may provide some relief
no evidence for acupuncture (probably placebo)
Lifestyle
only proven disease-modifying tx is weightloss (5kg)
physiotx-based exercise programmes
aerobic fitness
exercise bikes, walking, swimming
any will improve functional status
quads strengthening (resistance bands)
compliance NB
weakness a/w OA causes patients to exercise less, which in turn worsens their function - viscous cycle
non weight bearing exercises v good
walking good for functional fitness
both community + hosp based programmes effective
more aggressive programmes better early on - patients see results quicker + are merely likely to keep it up
educational programmes good (esp in groups)
proper foot wear
wide fitting deep shoes with rounded toe boxes + cushioned soles to maximise shock absorption
orthotics to realign foot to decrease forces acting on medial compartment in early OA
no backless slip on shoes
Occupational tx
can improve function
targeted approach - education + specific measures
joint protection + energy conservation
adaptive equipment + splinting
helps daily activities be possible (e.g. cooking, getting dress)
long shoe horns
hand rails
walk in shower
bath chairs
grab bars
Joint replacement surgery
major surgery
high success rate: >90% satisfaction for hips + slightly less for knees
excellent procedure for pain relief
patients must be prepared for some hard work after - long recovery
DVT prophylaxis NB
newer resurfacing procedures are giving younger patients better longterm outcomes
Bermingham hip
unicompartmental knee arthroplasty
only damaged parts of joint replaces
Heath promotion
must recognise enormous amount of patients
rational of physiological + OT
group programmes more efficient (defined no of visits)
emphasis of self-management