Nine out of 10 Australians with knee osteoarthritis could avoid surgery through targeted exercise programs, potentially saving taxpayers billions of dollars as knee replacement costs spiral toward $5.32 billion by the decade’s end.
The study found that the former could save Australia’s healthcare system $100 million annually.
Researchers also found that physiotherapist-led exercise programs are rarely subsidised by the federal government, which can push people towards surgical options before other conservative management approaches are considered.
Speaking to The Epoch Times, Scott Willis, national president of the Australian Physiotherapy Association (APA), said that this prospect is concerning.
“If we continue on the same pathway, it’s going to be very, very hard to fund all the amount of osteoarthritis conditions that we’re starting to see,” Willis said.
“At the moment, the total knee and total hip joint replacements are on a trajectory to get out of hand.
“I think there is an appetite for funders and governments to look at alternative models and different pathways that patients might actually go through; one, to give them better health outcomes, but also make it more efficient, more cost-effective, and provide a better pathway for patients.”
A Way Forward
The JAMA study assessed an education and exercise program called GLA:D (Good Life with osteoArthritis in Denmark), a structured physiotherapy program developed by Danish researchers for people with hip or knee osteoarthritis symptoms.In the program, patients are educated on osteoarthritis, its signs and symptoms, available treatment options, and self-management strategies, while the group exercise sessions target the strength and endurance of the knee and hip and include neuromuscular exercises that improve joint control and stability.
The researchers found that the program was cost-effective when restricted to individuals with no or mild knee pain but was not cost-effective over the lifetime horizon in those with moderate, severe, or extreme pain.
“Our results suggest that structured education and exercise therapy is cost-effective for the first 9 years and over the lifetime in individuals with low pain levels at baseline,” the study states.
The study also found that implementing a national education and exercise therapy program for knee osteoarthritis prior to total knee replacement would produce cost savings of $489,307,942 (US$318,368,133) or $7,970 (US$5,185) per person over the lifetime horizon compared with usual care.Other benefits include reducing surgery wait times by minimising unwarranted joint replacements, given that 30 percent of public patients wait over a year for a knee replacement.
Other physiotherapist-led programs apply similar principles, specifically physical activity, strength and control, weight loss, and education.
“The education is just as important as the exercise program,” Willis said.
“Because you want to try and educate the patient on not just the physical activity, but also some of their activities of daily living, what they can do to make it better, how they take their medication, what medication is right, does orthotics work or does bracing work, things like that.
“[I]n the past we kept saying that it was ‘wear and tear’ … your knee’s stuffed. We’re now starting to really educate people and say, ‘Physical activity can actually improve it.’
“We used to say we wanted to do non-weight-bearing exercise, but we know the weight-bearing exercise can actually be beneficial.
“It’s just working out what’s tailored for the individual, because some people would benefit from a certain exercise component, and others would find a benefit from somewhere else.
“The GLA:D program and other programs that are very similar go through all of that.”
The guidelines state that nine out of 10 people with knee osteoarthritis can manage without needing joint replacement surgery.
“Even a small amount of physical activity is better than none to improve your general fitness and to strengthen muscles around your joints.
“Even if you do need knee surgery, being physically active leading up to the surgery can improve your ability to recover and return to your usual activities after the operation.
Yet to Trend in the US?
While physiotherapist-led programs for knee osteoarthritis are gaining traction in Australia, the situation is different in the United States.Jean-Philippe Berteau, an associate professor from the City University of New York’s Department of Physical Therapy, told The Epoch Times that the reason for that is because the “lobbying” behind knee surgery is “too strong.”
Berteau said that exercise and weight management, as outlined in the Australian guidelines, are the only ways to help reduce osteoarthritis progression while decreasing pain in the long term.
“Knee surgery should be the last resort. We will save money by doing early diagnosis and physical therapy intervention as soon as possible,” he said, adding that insurance coverage for such programs is another barrier that prevents Americans from accessing similar programs.
Meanwhile, Willis said it is important that funders and governments understand physiotherapists’ work, their scope of practice, where the profession fits into the health system, and the value it brings.
The Australian guidelines also recommend that a person seek advice on surgery if they continue to experience severe knee pain after having tried a prescribed exercise and physical activity program or if the chronic condition is causing a lot of difficulty.
Both the American Orthopaedic Association and American Physical Therapy Association have been approached for comment.Reviews All Done, Government Action Needed, Says APA President
Willis hopes to see changes made to Australia’s current Medicare system, which would potentially see Medicare-funded group exercise sessions for chronic conditions such as knee osteoarthritis and chronic obstructive pulmonary disease.Currently, Australia’s Medicare system partially funds five one-on-one exercise sessions under the Enhanced Primary Care (EPC) plan on referral by a general practitioner (GP). But group exercise sessions are not covered.
Willis said that the current model is “very restrictive” and that one-on-one sessions may not be the best form of delivery.
Block funding is a lump sum payment allocated to the service provider, while bundled funding is a single payment for all services related to a specific treatment.
“We’re looking at trying to change Medicare from a sickness model to a wellness model,” Willis said.
“We’re looking at different pathways and different ways that we can actually get physiotherapists, exercise physiologists, dietitians, nutritionists, occupational therapists, all working to enable some of these preventative pathways rather than just waiting for surgery.
“The current government has done all the assessments, they’ve done all the reviews, they’ve got all the information now, they’ve just got to implement it.”
“Many of the recommendations will require collaboration between the Commonwealth and state and territory governments, as well as consultation with peak professional organisations, Ahpra, patient groups, and the sector more broadly. I look forward to these discussions,” federal health minister Mark Butler said.
Willis added that countries such as the U.S. are looking at what Australia is doing in this space.
“Talking to the Americans and our neighbours in the Asia-West Pacific—they’re looking to us to see what’s happening now, how we’re doing it, how we’re advocating, but also how the government’s responding as well,” he said.
“[They should] push their policymakers and their Congress to start funding preventative [health], just like we are here in Australia. I think they have got that impetus now to go forth and try and push them now.”
