CLINICAL MANAGEMENT OF OSTEOARTHRITIS FLARES: A SCOPING REVIEW OF BEHAVIORAL, LIFESTYLE AND ADJUNCTIVE TREATMENTS

Bowden, J.L.; Kobayashi, S.; Hunter, D.J.; Mills, K.; Peat, G.; Guillemin, F.; Parry, E.; Thomas, M.J.; Eyles, J.P.

Abstract

Purpose: Transient episodes of increased pain, swelling and stiffness are common in people with osteoarthritis (OA). These episodes, commonly known as OA flares, can be distressing, disabling, and prompt informal and formal care-seeking. Yet evidence-based strategies are seldom covered in clinical practice guidelines or training and this has been identified as an important gap by clinicians delivering OA care. This scoping review aimed to identify available evidence on behavioural, lifestyle or other adjunctive flare management strategies that could be used by clinicians or people with OA to lessen their impact. A second aim was to to identify descriptions of OA flares as outcomes among patients receiving treatment.
Methods: A Joanna Briggs Institute scoping review methodology was used. We undertook a literature search in three databases (MEDLINE, CINAHL, EMBASE). Studies were in English and published between 1990 and July 2020. The newly proposed flare definition by Guillemin and colleagues was widened to cover previously used definitions, including a flexible approach to time of symptom onset and duration. Quantitative or qualitative studies, reviews on OA flare management, or studies that reported data on OA flare outcomes ≤2 weeks post an intervention were included. Studies were required to report an active management strategy (e.g. exercise, educational programs, medical devices, adjunctive therapies) that could be implemented by a healthcare provider in a clinical setting (e.g. primary care, outpatient, community-based, telehealth), or could be performed safely at home. Outcomes included any physical or psychological OA outcome treatable with a therapeutic intervention. Surgical and post-surgical interventions, pharmacological or experimental therapies, or literature without original data were excluded. A risk of bias assessment was undertaken for any randomized controlled trials (RCTs) identified.
Results: Nine studies were included. Included studies examined the relationship between therapeutic exercise (n=8) or physical activity (n=1) and OA flares. All studies reported pain outcomes at the knee, and two also included the hip. Two studies were RCTs, three were secondary analyses from RCTs, three were observational studies, and one was a cross-sectional registry study. We did not identify any large, adequately controlled clinical trials, with all studies except the registry study having <120 participants. We did not identify any studies that examined other therapies commonly recommended by clinicians to manage an OA flare, including joint bracing/sleeves, non-weight bearing activities (e.g. swimming), cold/heat therapy, assistive devices, or electrotherapeutic devices (e.g. TENS). There were also few studies examining flare outcomes other than pain, or for joints other than the knee.

Citation

Bowden, J., Kobayashi, S., Hunter, D., Mills, K., Peat, G., Guillemin, F., …Eyles, J. (2022). CLINICAL MANAGEMENT OF OSTEOARTHRITIS FLARES: A SCOPING REVIEW OF BEHAVIORAL, LIFESTYLE AND ADJUNCTIVE TREATMENTS. Osteoarthritis and Cartilage, 30(S1), S396. https://doi.org/10.1016/j.joca.2022.02.532

• Journal Article Type: Conference Paper
• Conference Name: 2022 OARSI World Congress on Osteoarthritis
• Acceptance Date: Mar 28, 2022
• Online Publication Date: Mar 28, 2022
• Publication Date: 2022-04
• Deposit Date: Jun 21, 2023
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: S1
• Pages: S396
• DOI: https://doi.org/10.1016/j.joca.2022.02.532
• Keywords: Orthopedics and Sports Medicine; Biomedical Engineering; Rheumatology
• Additional Information: This article is maintained by: Elsevier; Article Title: CLINICAL MANAGEMENT OF OSTEOARTHRITIS FLARES: A SCOPING REVIEW OF BEHAVIORAL, LIFESTYLE AND ADJUNCTIVE TREATMENTS; Journal Title: Osteoarthritis and Cartilage; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.joca.2022.02.532; Content Type: simple-article; Copyright: Copyright © 2022 Published by Elsevier Ltd.