Shared decision making and self-management of osteoarthritis

Bannuru, 2019Kloppenburg, 2019Kroon, 2014Sakellariou, 2017

When osteoarthritis is diagnosed, the patient and their treating clinician should discuss the condition and its management, and explore the patient’s beliefs about the diagnosis and what the pain signifies to them, with the goal of achieving a shared understanding. The discussion should be tailored to the needs of the patient, their general health literacy, and their stage of acceptance of the condition. Clinicians should use positive and noncatastrophic language that is individualised to the patient’s disease stage, to empower the patient to proactively and positively manage their osteoarthritis. For patients with early osteoarthritis, avoid the use of terms such as ‘bone on bone’, ‘degenerative’, and ‘cartilage erosion’.

Patient education and self-management advice improves adherence and can help reduce pain, and improve physical function and quality of life, so should be reinforced at regular clinical review appointments.

Patient education should include discussion about:

• the likelihood of slow or minimal disease progression
• the fluctuating nature of osteoarthritis symptoms
• the poor correlation between symptoms and radiological findings of osteoarthritis
• modifiable risk factors for disease progression (see Risk factors for osteoarthritis)
• realistic management goals and expectations of treatment.

Strategies for self-management include:

• coping strategies for living with chronic pain (see also Psychological therapies for osteoarthritis)
• pacing physical activities (eg spreading physically hard jobs throughout the day with breaks in between to reduce sustained physical loading)
• lifestyle measures, such as exercise and weight loss
• use of physical aids (see Physical treatments for osteoarthritis)
• strategies to minimise symptoms when performing activities of daily living (often referred to as joint protection techniques); specific strategies are recommended for hand osteoarthritis (see Osteoarthritis of the hand) and similar principles may be applied to osteoarthritis of other joints
• topical or oral analgesia for evoked pain (see Topical NSAIDs and capsaicin for osteoarthritis and Paracetamol and oral NSAIDs for osteoarthritis)
• monitoring pain levels using a pain management diary.

The success of patient education and self-management largely relies on consistency in the messages provided to patients. Allied health professionals who are trained in both the management principles of osteoarthritis and in health coaching and behavioural change can assist in the education process (eg occupational therapists, physiotherapists, podiatrists). Evidence does not support a benefit from formal self-management education programs; however, these are unlikely to be harmful.

Printed or online information is useful to reinforce education and self-management advice. Patient support organisations such as Arthritis Australia provide educational materials, and participation in their activities may be valuable for social support; see the Arthritis Australia website for details. The My Joint Pain and painHEALTH websites also provide useful tips for self-management.