Explore this issueJanuary 2019
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“How should I proceed and figure out what to do with our patients?” asked David T. Felson, MD, MPH, professor of medicine at Boston University School of Medicine, during OA Management Without Surgery in 2018, a session at the 2018 ACR/ARHP Annual Meeting. He also shared tips on how to interpret the effect size of clinical trial meta-analyses to see how available therapies work and compare to each other.
Pain is not patients’ only concern. Between 14% and 26% of patients with knee OA experience periodic knee buckling, and limit activity as a result, he said.1 “I had one patient who couldn’t go down to a basement and had to have her daughter come over to do her laundry,” he said. Her knees buckled when she walked downstairs, “and she was very scared she was going to fall.”
Patients with frequent, bothersome knee buckling should be referred to physical therapy (PT). “I don’t just refer patients to physical therapy. I instruct the physical therapist about exactly what I want.” To address muscle weakness that is the likely cause of the buckling, he prescribes functional closed-chain quadriceps strengthening and balance training. (Note: Chains are links of body parts, such as foot, ankle, knee and hip during walking. In a closed chain, the end of the chain farthest from the body is fixed, such as a squat where your feet are fixed and the rest of the leg chain moves.)| | | Next → | Single Page