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Tweed “SOS” Clinic Specialised Osteoarthritis Screening The Joint Approach Luke Schultz Project Lead
Tweed “SOS” Clinic
Specialised Osteoarthritis Screening
The Joint Approach
Luke Schultz
Project Lead
Intro to the Tweed……. Age Tweed % NSW %
50-59 13.5 13.6
60-69 11.6 10.3
70-84 14.1 9.8
> 85 2.5 1.9
> 60 28.2 22.0
Diagnostics ….Joint replacements??
•350+ joint replacements annually
•70% knee, 30% hip
•76% NSW residents
•> 250 on waitlist…….+ those waiting to starting
waiting ??
“it’s on the rise !”
Diagnostics……conservative management??
For those currently receiving joint replacement …..
• > 80 % had not received conservative treatment prior to surgery
• > 50% not to any regular pharmaceutical pain management.
• Generally poor physical health + multiple comorbidities
• Poor understanding of OA and causes of JOINT PAIN
• “I have bone on bone arthritis – I must have an operation”
“hurry up and
wait”
Current Hip and Knee OA journey……………..
Pills and waiting for surgery
Conservative management
Waiting to see the Surgeon
Surgeon – RFA for Surgery
Waiting for Surgery
The ‘Joint’ Approach Project
FFS …??
What should we be doing ?? Core non-pharmacological
treatment includes patient
education and self-
management, exercise,
and weight loss for those
who are overweight.4, 19
Conservative management
is recommended at all
stages of the disease.2, 4, 1
Primary Health….the big issue!
“What Physio??”
It takes a team……
The Business Case …… what was the model
• Based on the big 3 – • Holistic assessment (based on OACCP MoC) • Education (self-management) • Exercise • Weight loss • Referral – affordable, accessible, goals based • Review – 1month, 3 months, 6 months … (or as indicated)
• Scope • Hip and Knee • Pre waitlist only (on the “pathway” to joint replacement surgery) • Public patients only from Tweed/Byron area
• Focus • Self management (supplement with myOA program) • Coach not cure • Primary Health (GP) – “advise and assist”
• Permanent FT Msk coordinator (Physio) plus additional Allied Health hours for weight loss + exercise.
The ‘SOS’ Clinic
Specialised
Osteoarthritis
Screening
The ‘SOS’ Clinic
What did we get …..????
• 3 Day a week service
• Msk Coordinator (Physio) role
• 12 month “Proof of Concept”
Getting Ready …..Recruitment
Getting Ready …GP’s outreach……
The Joint Approach
Dinner Launch
…… OR Fax
So what’s happened ??
•“SOS Clinic” - 60 days of operation over 5 months
• Initial n=80 •1 month follow up n=40 •3 month follow up n=12 •myOA group exercise and education program – 16
groups (ave. 4-6 per session)
Patient Profile
Patient Profile
Weight and Waist
Normal 7.5% Overweight 31% Obese 30% Morbidly Obese 19% Super Obese 12.5%
Physical scores ?? Averages: 40mFPW – 37 seconds 30sChair stand – 10 stands TUG – 9.35 seconds
Changes - 40mFPW Initial average – 37.12 secs 1 month follow up – 32.1 secs
Changes - TUG Initial average – 9.35 sec I months - 8.1 sec
Changes - 30s Chair Stand, Initial – 10.1 stands 1 Month – 11.7
Function (Oxford) Initial average – 19.7 I month – 25 3 month – 28.5
Pain For the 40 clients reviewed at 1 month: average pain changed from 5.4 on initial review to 4.3 on 1 month follow up
For the 12 patients seen at 1 mth and 3 mths Initial – 5.7 1 month – 3.7 3 months – 2.6
Weight and Waist
In general since my last appointment my Walking has…… 69% reported a little to a lot of improvement at 1 month, 75% improved at 3 months
In general since may last appointment my knee/hip has …….
67% reported a little to a lot of improvement at 1 month, 67% still improved at 3 months
Willingness for surgery ??
35%
62%
3%
Willing for Surgery?
Yes No Unsure
What did we learn….
• Recruit wisely
• Keep it simple
• GP’s just wanna know (medical objects)
• Talk to your local GP clinics and surgeons (invite yourself to their meetings)
• “What gets measured gets done”
• Health coaching – self management – find what’s important to them and set some goals from there
• Coach don’t cure
Where to now…… •7 months left in trial
•Sustain and spread
•…..OACCP model of care being rolled out across the LHD.
•Reports to PHN and GP’s – Share the love
•Reports to ACI
Case Study 1 • 48 y.o female referred by Ortho Surgeon for (R) knee pain. 18 month history of knee pain post
workplace accident. On/off knee problems for past 15 years, previous meniscectomy.
• Reports pain as 9/10 by end of the day, constant ache and stinging/burning sensation medial knee
• Regularly clicking, clunking, locking, giving way
• x2 jobs. Works at food packaging plant and assistant and dairy farm (access to free milk, cream, cheese)
• Walks dogs 15mins daily. Incidental exercise at work. Nil other
• Panadol Osteo PRN -> mostly after day at work
Case Study 1
• X-ray: Moderate to severe OA of the medial compartment including near complete loss of joint space during weight bearing.
• MRI: Extensive complex tear of the medial meniscus
• PMHx: Bipolar
• Patient willing++ for surgery, advised by Ortho Surgeon too young for TKR
• Reports “would definitely take surgical option if it was made available”
Case Study 1
• Waist 126cm
• Weight: 120.5kg
• Height 167cm
• BMI 43.4 -> obese
• TUG: 8.9 secs -> below average for age group
• 40m fast paced walk: 35.27 -> below average for age group
• 30 sec STS: 10 -> below average for age group
• Oxford: 14 -> severe functional impairment
• DASS 21 -> normal levels for stress, anxiety, depression
Case Study 1 – Interventions
Education: • OA
• Benefits of exercise/activity and associated benefits for OA
• Busting OA related myths -> exercise not going to worsen OA, exercise not going to cause further damage, pain with exercise does not equate to harm
• Diet/weight loss and associated benefits for OA
• Pacing, self management of flare ups
• Appropriate pain relief use (Panadol Osteo) and timing with exercise/activity to aid completion of
Case Study 1 - Interventions
• Exercise • IRQ, SLR, Bridges at initial Ax
• Added mini squats 1 month r/v
• Added STS and SL balance 3 month r/v
• Walking – dog and incidental at work
• Referral • Recommendation to GP for Dietician referral (commenced)
Case Study 1 – Outcomes
Initial 1 month 3 months
Pain 9/10 2/10
Weight 120.5 123 -> dietician 121.3
Waist 126cm 117cm
Oxford 14 19 30
DASS 14 12 7
30 sec STS 10 11 12
40m FPW 35.3 31 26.7
TUG 8.9 7.5 6.4
Case Study 1 – Assessment Questions
• My walking on level ground is moderately improved
• In general my knee is moderately improved
• Do you want to have joint replacement surgery –> Unsure
Case Study 1
• “Less knee pain. Less clicking and clunking”
• “Decreased feelings of weakness or going to give way”
• “Tolerating jobs at work with more ease”
Luke Schultz
The ‘Joint’ Approach - Project Officer - The Tweed Hospital | Integrated Care Tel 07 5506 7027 Mobile 0418 974467 [email protected]
Evan Bryant Physiotherapist | Specialised Osteoarthritis Screening (SOS) Clinic Tweed Heads Community Health Centre
Level 3 Florence Street TWEED HEADS NSW 2485 Tel 07 5506 7541 | Fax 07 5506 7578 [email protected]
