Osteoarthritis Consultation Guide

Education topics (5 mins each consultation)

Education and discussion should be an ongoing two-way process that is a key component of every osteoarthritis consultation. We recommend discussing the different information topics contained in the “Osteoarthritis Information” booklet (available in the Resources section for learners who choose the course upgrade option). The following diagram outlines what to discuss, and when.

Osteoarthritis Consultation 2

In order to ensure your patient has sufficient knowledge and understanding of why a physical activity program can benefit their knee OA, some education is required prior to prescribing the physical activity plan. Thus, in this session we recommend discussing the benefits of physical activity, as well as activity pacing (and how to do it).

Osteoarthritis Consultation 3

It is important that people understand the basis of the pain experience and understand that the way they think about and interpret pain can change their experience of pain. It is also helpful to point out some simple techniques that the patient can use to help manage their pain.

Osteoarthritis Consultation 4

It is important that people with knee OA understand that being overweight or obese can increase the forces applied to their knee joint during every step they take, which places them at increased risk of experiencing more severe knee pain and physical dysfunction than if they were of healthy body weight. In addition, being overweight or obese means they at increased risk of structural OA disease progression over time. Even if your participant is currently of healthy body weight, you must educate them about the importance of maintain a healthy body weight for life, to ensure the best outcomes for their knee.

Tips for having a weight loss conversation
It can be awkward having a weight loss conversation with a patient who is overweight or obese. It is very important to acknowledge that weight is a sensitive issue, and our own attitudes towards, or misunderstandings about, overweight can subconsciously create a bias against people that are overweight, which can be harmful for patient outcomes. The most important pre-requisite for health care practitioners having discussions with patients about weight loss is to appreciate the complexity of the causes of overweight, obesity and weight gain. While energy intake and energy output balance are central to weight control, all contemporary research shows that there are many overlapping factors to weight including physiological changes that oppose weight loss in individuals, genetic factors, societal and environmental factors. In this program, patients receive information about energy balance.

Consider the following when discussing body weight with your patient:

• Ensure the patient is fully clothed and preferably not in front of a mirror
• Ensure you have complete privacy from other patients or practitioners in the clinic

Consider your language when discussing body weight:

• Introduce weight management as an important component of a “package of care” for knee osteoarthritis (OA)
  “We have been working on a range of strategies to help you manage your knee problems, we’ve looked at some exercises, physical activity, and discussed pain coping strategies. There are a few other things that you can consider to help you moving forwards.”
• If your patient is overweight or obese, present weight loss as being helpful
  “For some people, they find losing 5-10% of their body weight can be very helpful in reducing pain and improving symptoms.”
• If your patient is willing/interested in exploring weight loss options, encourage them to make an appointment with their GP. You may wish to provide a referral letter to facilitate this.

Osteoarthritis Consultation 5

In the final consultation, it is important to discuss with the patient how to modify and progress their own strengthening program and physical activity plan themselves, once consultations have ceased. It is also important that the patient knows how to deal with lapses and set-backs with adhering to their exercise program and physical activity plan. The critical issue is to get back on track when adherence wanes or when motivation falls. The “Exercise Booklet” (available in the Resources section for learners who choose the course upgrade option) contains helpful information to discuss.