Background:
Facing the problems of ageing population, knee osteoarthritis (OA) will generate more and more impact on the health care system. The median waiting time for total joint replacement (TJR) surgery among hospitals in 7 clusters of Hospital Authority (HA) in 2020 ranged from 16 to 28 months, which has risen to 27 to 56 months in 2022. The increasing waiting time indicates a need for an innovative approach for management of this group of patients. Growing international experiences suggested structured progressive exercise regime and self-management program as effective conservative management for knee OA (1,2).
New Care model of Structured Non-surgical Treatment Program (SNTP):
A four-year physiotherapy program was first launched in June 2020 in Yan Chai Hospital, Kowloon West Cluster to deliver holistic education, exercise empowerment and longer follow-up period to knee OA patients who were on the TJR waitlist. The program was extended to other 6 Clusters later from 2021 to 2022. It aimed to provide regular monitoring, reporting of symptoms and physical function to orthopedic team, pre-habilitation concept by case management approach for better post-operation outcomes and optimizing physical functions of the patients. The program started with the induction phase in the first year including 4-6 sessions of out-patient physiotherapy led by a physiotherapy case manager, and then followed by the maintenance phase from the second to fourth year with 2 booster sessions per year. Tele-care refresher class in-between booster sessions were introduced to patients in need. The course content covers introduction to disease progress of knee OA, therapeutic exercise, motivation and behavioral modification, coping strategy and self-management techniques and weight management advice. A wide spectrum of different service modes was adopted such as individual assessment and treatment, group exercise and sharing class, education talk, hydrotherapy class and tele-care session. Close communication among the case manager, the patient and the orthopedic specialist facilitate the timely clinical decision likes advancing, postponing or even withdrawal from the surgery because of the improvement after the self-management approach. For the stable patients, they can be referred for maintenance program with District Health Centre (DHC).
The preliminary evaluation of the SNTP patients in the first and second year of follow-up showed positive outcomes in decreasing pain and disability level and improving physical function. SNTP demonstrates promising effects for the OA knee patients on the TJR waitlist in preventing the deterioration of their clinical conditions and hence minimizing the need for surgery.
