Knee osteoarthritis management
Some observations from the 2024 Osteoarthritis of the Knee Clinical Care Standard...
In August 2024, the Australian Commission on Safety and Quality in Health Care (ACSQHC) updated the Osteoarthritis of the Knee Clinical Care Standard. The ACSQHC’s role is to enhance the consumer healthcare experience and optimise the Australian healthcare system via coordination of safety and quality initiatives. One way the ACSQHC fulfills these roles is to prepare clinical care standard documents that provide a foundational summary for provision of evidence-based healthcare services. The Osteoarthritis of the Knee Clinical Care Standard was first released in 2017 and the most recent update was released in 2024, below is a summary of some interesting observations I have taken from the standard.
Before we get started, Knee Osteoarthritis?
Osteoarthritis (OA) is a chronic, inflammatory disease that affects many of the body’s joints. Knee OA is often experienced as knee pain, swelling and stiffness. These symptoms can often affect an individual’s physical function, some activities a person experiencing knee OA may find challenging are walking, climbing stairs and ascending/descending into (or out of) a chair. Knee OA affects people of all ages, however in populations aged 45-plus it is more prevalent.
Person centred assessment
Quality statement one asks healthcare providers when assessing a patient to be mindful of an individual’s holistic experience(s). Knee OA often negatively impacts function of the lower limbs, which may then affect an individual’s psychosocial health. For example, a person experiencing knee OA may live in a second storey apartment and struggle with the building’s stairs. Because of this barrier, they leave the apartment less and in time may experience a sense of social isolation. People are more than their knee OA diagnosis, they are individuals, with uniquely human experiences, so I feel like this is an important part of the clinical care standard.
Another part of quality statement one I feel is important involves the healthcare practitioner explaining the nature of knee OA to patients. There are often multiple elements that inform a knee OA diagnosis and the prevailing understanding in the community involves the idea of ‘wear and tear’. I feel like this narrative is simplistic, unhelpful and needs to be challenged, knowledge is power for people experiencing knee OA.
Imaging
Quality statement two asks that imaging (X-ray, MRI, CT scans) are not routinely used to diagnose knee OA. Most of the time a good knee OA diagnosis can emerge from a thorough assessment. Scans can cause unnecessary concern, instead the statement asks healthcare providers to prioritise an individual’s movement experiences, goals and ability to engage with meaningful activities. In my own professional experience, I have seen knee scans that show lots of OA for active individuals that only experience occasional discomfort, oppositely I have seen scans that show small amounts of knee OA for people with large functional deficits. Scans are only a small part of a knee OA diagnosis and should be used judiciously.
Physical activity
Quality statement four asks that an individual experiencing knee OA is advised by their healthcare provider that physical activity and exercise can be helpful for managing pain and improving function. Rather than being a risky or dangerous endeavour, the statement frames physical activity as a safe activity that should be incorporated into knee OA treatment. This statement reflects the large amounts of evidence that supports the positive role exercise can play in knee OA management. To enact this statement a healthcare professional must feel comfortable providing physical activity guidance, they must be mindful of their client’s needs and preferences, they must also advise clients that exercise does not equate to damage for an osteoarthritic knee. Some exercise skills a healthcare provider supporting people experiencing knee OA could be exercise prescription, exercise modification, load management, health coaching, goal setting and exercise progression.
This post is the first of two, focused on the Osteoarthritis of the Knee Clinical Care Standard. The next post (September 2025) will look at some observations regarding medications, healthcare review and surgery for people experiencing knee OA.
Thanks for reading, Warwick (Movement Health, Forster Tuncurry Massage)..
(If you found this article helpful and would like to support my writing, you could, shout me a coffee).
Australian Commission on Safety and Quality in Health Care (2024). Osteoarthritis of the Knee Clinical Care Standard. https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf
Australian Commission on Safety and Quality in Health Care (2024). Osteoarthritis of the Knee Clinical Care Standard – Guide for consumers. https://www.safetyandquality.gov.au/sites/default/files/2024-08/consumer-guide-osteoarthritis-knee-clinical-care-standard.pdf
*Disclaimer, this is a discussion and does not represent an exercise prescription, for exercise or injury advice seek an appropriately trained health professional.