EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update

Tuva Moseng; Theodora P M Vliet Vlieland; Simone Battista; David Beckwée; Vladimira Boyadzhieva; Philip G Conaghan; Daniela Costa; Michael Doherty; Andrew G Finney; Tsvetoslav Georgiev; Milena Gobbo; Norelee Kennedy; Ingvild Kjeken; Féline P B Kroon; L Stefan Lohmander; Hans Lund; Christian D Mallen; Karel Pavelka; Irene A Pitsillidou; Margaret P Rayman; Anne Therese Tveter; Johanna E Vriezekolk; Dieter Wiek; Gustavo Zanoli; Nina Østerås

doi:10.1136/ard-2023-225041

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update

Ann Rheum Dis. 2024 Jan 11:ard-2023-225041. doi: 10.1136/ard-2023-225041. Online ahead of print.

Authors

Tuva Moseng¹, Theodora P M Vliet Vlieland², Simone Battista³, David Beckwée⁴, Vladimira Boyadzhieva⁵, Philip G Conaghan⁶, Daniela Costa⁷, Michael Doherty⁸, Andrew G Finney^{9

10}, Tsvetoslav Georgiev¹¹, Milena Gobbo¹², Norelee Kennedy¹³, Ingvild Kjeken¹⁴, Féline P B Kroon^{15

16}, L Stefan Lohmander¹⁷, Hans Lund¹⁸, Christian D Mallen¹⁹, Karel Pavelka²⁰, Irene A Pitsillidou²¹, Margaret P Rayman²², Anne Therese Tveter¹⁴, Johanna E Vriezekolk²³, Dieter Wiek²⁴, Gustavo Zanoli²⁵, Nina Østerås¹⁴

Affiliations

¹ Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway tuva.moseng@diakonsyk.no.
² Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Leiden, Netherlands.
³ University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health, Genova, Italy.
⁴ Rehabilitation Research Department, Vrije Universiteit Brussel, Brussel, Belgium.
⁵ UMHAT "St. Iv. Rilski" Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria.
⁶ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomechanical Reserch Centre, Leeds, UK.
⁷ Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal.
⁸ Department of Academic Rheumatology, University of Nottingham, Nottingham, UK.
⁹ Research Institute for Primary Care and Health Sciences, Keele University School of Medicine, Keele, UK.
¹⁰ School of Nursing and Midwifery, Keele University, Keele, UK.
¹¹ Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine, Medical University Varna, Varna, Bulgaria.
¹² Positivamente Centro de Psicología, Madrid, Spain.
¹³ School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland.
¹⁴ Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
¹⁵ Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
¹⁶ Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands.
¹⁷ Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
¹⁸ Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.
¹⁹ Keele University School of Medicine, Keele, UK.
²⁰ Institute of Rheumatology, Department of Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic.
²¹ EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus.
²² Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK.
²³ Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands.
²⁴ EULAR Patient Research Partner, Deutsche Rheuma-Liga, Bonn, Germany.
²⁵ Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Novara, Italy.

PMID: 38212040
DOI: 10.1136/ard-2023-225041

Abstract

Introduction: Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.

Methods: The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.

Results: The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.

Conclusions: The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

Keywords: Osteoarthritis; Osteoarthritis, Knee; Physical Therapy Modalities; Rehabilitation; Therapeutics.

© European Alliance of Associations for Rheumatology, EULAR 2024. Re-use permitted under CC BY-NC-ND. No commercial re-use. No derivatives. See rights and permissions. Published by BMJ on behalf of EULAR.