The study: Garg S, Rovin B, Astor BC, et al. Hydroxychloroquine associated with lower glomerular filtration rate decline in lupus nephritis. Arthritis Care Res (Hoboken). 2025 Jul 20. Epub ahead of print.
Referrals to PT for Managing Knee OA
By Samannaaz S. Khoja, PT, PhD, Joel M. Stevans, DC, PhD, Gustavo J. Almeida, PT, PhD, Clair Smith, MS, & Janet K. Freburger, PT, PhD
Why was this study done? Physical therapy (PT) can be an impactful and cost-effective intervention during the early management of knee osteoarthritis (OA) and has been linked to better patient outcomes, lower opioid use and lower healthcare costs. Initial care of knee OA is largely driven by physicians, with patients mostly seeking PT through physician referrals. This study aimed to describe the frequency and timing of physician referrals to PT, and the frequency of other knee OA treatments prescribed over 12 months in patients with a recent knee OA diagnosis. We also examined patient, practice and physician factors associated with early PT referrals.
What were the study methods? This retrospective study used electronic medical records (EMR) from an integrated healthcare system. Visits for new onset of knee OA symptoms were identified using ICD-10 codes. Early PT referral was defined as a referral by the same physician within 15 days of the initial knee OA-related visit. EMR data included PT referrals, knee OA treatments, patient, physician and practice characteristics. We used a public dataset to obtain counts of licensed PTs within the counties where practices were located. We used generalized linear mixed models to examine factors associated with early PT referrals.
What were the key findings? In patients with recent onset knee OA, 26% received at least one PT referral within 12 months, but only 17% received an early PT referral (within 15 days). Oral pain medications and therapeutic injections were among the most frequently prescribed treatments, while lifestyle counseling was among the least. Early PT referrals were less likely in those with higher or missing knee pain scores and those seen in rural practices, and more likely in women, patients with higher BMI and in counties with a greater number of PTs.
What were the main conclusions? Physician referrals to PT for early management of knee OA are infrequent and may be influenced by patient and practice factors.
What are the implications for patients and clinicians? Non-pharmacological knee OA approaches are underused, despite being recommended as frontline treatment in clinical practice guidelines. This study underscores the need to improve the access and delivery of PT and lifestyle interventions for knee OA.
