Authors (including presenting author) :
Tam WY (1), NGAN GYK (1), NG CL (1), TSE CW (1), TO WKR (1)
Introduction :
Osteoarthritis (OA) knee is a common condition among the elderly and imposes substantial economic burden to the society. To address the growing demand for Structural Non-Surgical Treatment Programs (SNTP) for knee OA, a stratified care model with three levels of care (fundamental, semi and full) has been proposed. This model tailors treatment to patients with low, moderate, and high levels of impairment and disability.
Objectives :
This study aimed to evaluate the effectiveness of Stratified SNTP implemented at the outpatient physiotherapy department of Pok Oi Hospital, through retrospective data analysis using the Clinical Data Analysis and Reporting System (CDARS).
Methodology :
This retrospective study included 733 patients referred for SNTP between 1 April 2024 and 30 September 2024 who completed all induction sessions. Outcome measures included the Numeric Pain Rating Scale (NPRS), Body Mass Index (BMI), 30-Second Chair Stand Test (30CST), and Knee Injury and Osteoarthritis Outcome Scores for Pain (KOOS-KP), Physical Function (KOOS-KPS), and Quality of Life (KOOS-KQ). Pre- and post-treatment outcomes were analyzed using the Wilcoxon signed-rank test and paired t-test within the semi, full and fundamental SNTP groups respectively.
Result & Outcome :
Of the 733 patients, 438 were triaged to full SNTP, 221 to semi SNTP and 74 to fundamental SNTP. Patients in the full SNTP group showed significant improvements in NPRS (from mean of 7.02 ± 1.76 to 6.42 ± 2.1, z= 1.97, p=0.049), 30CST (from mean of 6.89 ± 3.97 to 8.56 ± 4.55, z= 2.587, p=0.01), and KOOS KP (from mean of 44.35 ± 18.93 to 48.70 ± 18.97, p=0.035). While improvement in KOOS KPS (from mean of 51.84 ± 18.49 to 53.24 ± 18.84) or KOOS KQ (from mean of 28.58 ± 20.21 to 29.67 ± 18.34) was observed, it was not statistically significant. On the other hand, BMI significantly increased (from mean of 28.48 ± 5.24 to 29.05 ± 5.39, z= 3.642, p< 0.001). In the semi SNTP group, no significant changes were found in NPRS (from mean of 4.8 ± 1.58 to 4 ± 2.35), BMI (from mean of 27.74 ± 4.72 to 28 ± 4.64), KOOS KP (from mean of 60.48 ± 14.89 to 62.64 ± 15.52), KOOS KPS (from mean of 66.88 ± 15.62 to 65.84 ± 14.46) or KOOS KQ (from mean of 46.24 ± 20.85 to 44 ± 20.49), though a significant improvement was noted in 30CST (from mean of 8.6 ± 4.84 to 10.36 ± 4.45, z= 2.366, p=0.018). Patients in the fundamental SNTP group demonstrated significant improvements in NPRS (from mean of 3.06 ± 2 to 2.48 ± 1.82, p=0.02), 30CST (from mean of 9 ± 3.70 to 10.77 ± 3.96, p< 0.001), KOOS KP (from mean of 64.07 ± 19.99 to 70.03 ± 15.23, p< 0.001), KOOS KPS (from mean of 64.87 ± 14.02 to 71.03 ± 13.17, p< 0.001), and KOOS KQ (from mean of 44.60 ± 13.67 to 50.77 ± 13.43, p< 0.001). While slight reduction in BMI was observed (from mean of 27.12 ± 3.88 to 27.09 ± 3.67), it was not statistically significant. The findings of this study demonstrate that Stratified SNTP is effective in reducing pain, improving physical function, and enhancing the quality of life in patients with knee osteoarthritis, particularly those in the fundamental and full SNTP groups. While the semi SNTP group showed limited improvements, the stratified care model overall appears to be a feasible approach to addressing the growing demand for conservative knee OA treatments. Further research is recommended to optimize the stratification process and enhance outcomes for patients with moderate
