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Management of Osteoarthritis by

Core 1 - Offered to everyone - Inform­ation

We can treat OA
Progre­ssion is far from inevitable and can be reversed
Self-m­ana­gement strategies
Exercise, weight loss, suitable footwear, thermo­therapy and pacing

Adjacent Parace­tamol & topical NSAIDs

If parace­tamol or topical NSAIDs are insuff­icient for pain relief for people with osteoa­rth­ritis, then the addition of opioid analgesics should be consid­ered.

Adjacent - Nutrac­eut­icals

Bluebe­rries
Montom­erency Cherrry Juice
Turmeric

Biologics

Platlet Rich Plasma (PRP)
Anti-i­nfl­amm­atories
Stem Cell Therapies
Potential tissue re-growth
Nerve Growth factor antibodies
Anti-i­nfl­amm­atories and analgesia
Fibroblast Growth Factor
Chondr­opr­ote­ctive
 

Core 2 - Offered to everyone - Exercise

Aerobic
Stationary cycling, and walking, yoga and Tai Chi
Streng­thening
Knee OA usually presented with hip muscle weakness and likely to have loading on the inside of knee joint
 
Hip streng­thening exercises tend to improve the mechanics of your lower limb and reduce stress on the knee
 
Unclear weather weight­-be­aring or non-we­igh­t-b­earing is most effective. But ld increase the diversity of therapy and possibly improve compliance
 
A meta-a­nalysis reported no evidence that the type of streng­thening contra­cti­on(­iso­metric, isotonic or isokin­etic) influences the outcom.
Balance
A randomized study demons­trated that the addition of kinaes­thesia and balance exercises to a streng­thening program did not offer any addit­ional improvemen
Dose
High-i­nte­nsity training might result in greater strength gains than lowin­tensity training but could potent­ially overload the joint and exacerbate symptoms such as pain and swelling
 
High-r­esi­stance strength training > low-re­sis­tance, even with both groups experi­encing the same overall work
 

Core 3 - Offered to everyone - Obestity

Goal Setting
The distin­ction between losing weight and mainta­ining weight loss, and the importance of developing skills for both; advise them that the change from losing weight to mainte­nance typically happens after 6 to 9 months of treatment
 
Realistic targets for outcomes other than weight loss, such as increased physical activity and healthier eating
Self-Care
If a person (or their family or carers) does not feel this is the right time for them to take action, explain that advice and support will be available in the future whenever they need it. Provide contact details so that the person can get in touch when they are ready and voluntary organi­sations and support groups and how to contact them.
Psycol­ogical
self-m­oni­toring of behaviour and progress
 
stimulus control & slowing rate of eating
 
Ensuring social support & assert­iveness
 
Problem solving, cognitive restru­cturing (modifying thoughts) reinfo­rcement of changes
 
Cognitive restru­cturing (modifying thoughts) reinfo­rcement of changes
Diet
Diets that have a 600 kcal/day deficit (that is, they contain 600 kcal less than the person needs to stay the same weight) or that reduce calories by lowering the fat content (low-fat diets), in combin­ation with expert support and intensive follow‑up, are recomm­ended for sustai­nable weight loss
 
Do not routinely use very-l­ow-­calorie diets (800 kcal/day or less) to manage obesity (defined as BMI over 30).
 
Be mindful very-l­ow-­calorie diets (800 kcal/day or less) to manage obesity (defined as BMI over 30) are unlikely to be nutrit­ionally complete
 

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