Osteoarthritis

The Osteoarthritis (OA) Tool is designed for primary care providers who are managing patients with new or recurrent joint pain consistent with OA in the hip, knee or hand.

Question #1: True or false? If your patient has more than 30 minute of stiffness in the morning, you do not need to proceed to the inflammatory screen.

Question #2: Intra-articular corticosteroid injections are not recommended for osteoarthritis of the hand.

Next

Tool

Osteoarthritis Tool
the tool

Download Français
The Osteoarthritis (OA) Tool was developed for primary care providers managing patients with new or recurrent joint pain consistent with OA in the hip, knee or hand. This tool can help clinicians identify symptoms and provide evidence-based, goal-oriented non-pharmacological and pharmacological management while identifying triggers for investigations or referrals.

Divided into three sections, the tool focuses on the following:

  • Patient history
  • Physical examination
  • Diagnosis
  • Management

Feedback View other tools

Project Overview

Development Process

The Osteoarthritis Tool was developed using the CEP’s integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership of the resource was provided by Dr. Julia Alleyne. A group of clinical and system experts were also engaged to provide feedback on the tool.

The Osteoarthritis Tool was developed based on a need identified by the Arthritis Alliance of Canada (AAC) and suggested this to the College of Family Physicians of Canada (CFPC). The AAC along with the CFPC engaged the Centre for Effective Practice to develop a clinical tool for primary care providers across Canada.

Meet the Team

The Centre for Effective Practice enlisted the collaboration of clinical leads and a clinical working group to create the tool.

Clinical Lead

NameJulia Alleyne, MD, CAC (SEM), FCFP
Dr. Julia Alleyne is a family physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an associate clinical professor.

In 2009, she completed her Masters with a focus in Health Professions Education. Since that time, she has been active as an educational curriculum consultant including acting as the clinical lead for Ontario’s Low Back Pain Strategy and program designer for the MSK Initiative in British Columbia. In 2013, she was appointed as the first Family Physician to be chair of Bone and Joint Canada.

In addition, Dr. Alleyne’s work in the area of back care includes being an educational consultant for curriculum and tool development for provincial MSK initiatives in Ontario and British Columbia. She has co-authored a series of spine related articles for Current Concepts in Care and is the co-chair for the Spine Quality Based Pathway. Dr. Alleyne has worked with the Centre for Effective Practice for a decade in the area of Primary Care Musculoskeletal tool development and education.

Acknowledgements

A clinical working group and steering committee oversaw the development of this tool. Members include:

Clinical Working Group
  • Dr. Matthieu Lafontaine-Godbout
  • Dr. Victor Lun
  • Dr. Pierre Frémont
  • Dr. Sahil Jain
  • Dr. Gillian Hawker
  • Carol Cox – Patient representative
Steering Commitee
  • Dr. Gillian Hawker
  • Dr. Jamie Meuser
  • Dr. Laura Cruz
  • Dr. Natasha Gakhal
  • Louisa Crane – Patient representative

Thank you to all of our members for their work.

Supporting Material

Here are some additional resources and sources of information. These supporting materials are hosted by external organizations and we cannot guarantee the accuracy and accessibility of their links. CEP will make every effort to keep these links up to date.

References

  1. Hawker et al, Understanding the pain experience in hip and knee osteoarthritis – an OARSI/OMERACT initiative. Osteoarthritis and Cartilage 16, 415-422 http://www.oarsijournal.com/article/S1063-4584(07)00403-7/fulltext
  2. BC Practice Support Program. March 2016. Ver 7.8 Available: http://www.gpscbc.ca/sites/default/files/OA%20RA%20Algorithm%20ver%207%206_0.pdf
  3. Getting a Grip on arthritis. Best Practice Guidelines. The Arthritis Society. 2017
  4. Adapted from Physicians of Ontario Collaborating for Knowledge Exchange and Transfer (Red and Yellow Flag Cards) Available https://www.iwh.on.ca/system/files/documents/pocket_flag_cards_2008_sheet.pdf
  5. New Zealand Guidelines Group. New Zealand acute low back pain guide: Incorporating the guide to assessing psychosocial yellow flags in acute low back pain [Internet]. 2004 Oct [cited 2015 Nov 25]. Available from: http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/guide/prd_ctrb112930.pdf
  6. Cook C, Hededus E. Orthopedic Physical Examination Tests: An Evidence-Based Approach. 2nd ed. Pearson 2015
  7. Centers for Disease Control and Prevention, The 30-Second Chair Stand Test, https://www.cdc.gov/steadi/pdf/30_second_chair_stand_test-a.pdf
  8. British Columbia Guidelines and Protocols Advisory Committee. Osteoarthritis in Peripheral Joints – Diagnosis and Treatment. 2008 Sep 15 http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/oa.pdf
  9. Blyth M, Anthony I, Francq B, et al. Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis. Health Technology Assessment, No. 19.62. 2015. https://www.ncbi.nlm.nih.gov/books/NBK310281/
  10. Arthritis Research UK. Examination of the hand and wrist. http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/rems/examination-of-the-hand-and-wrist.aspx
  11. American Academy of Orthopaedic Surgeons, De Quervain’s Tendinosis-OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=a00007
  12. Niu J, Zhang Y, Torner J, Nevitt M, Lewis C, Aliabadi P, et al. Is Obesity a Risk Factor for Progressive Radiographic Knee Osteoarthritis? Arthritis Rheum. 2009;61(3):329-35.
  13. Dunlop D, Song J, Lee J, Gilbert A, Semanik P, Ehrlich-Jones L et al. Physical Activity Minimum Threshold Predicting Improved Function in Adults With Lower-Extremity Symptoms. Arthritis Care & Research. 2017;69(4):475-483.
  14. Hochberg M, Altman R, April K, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Phar-macologic Therapies in Osteoarthritis of the Hnad, Hip and Knee. Arthritis Care & Research. 2012;64(4):465-74
  15. McAlindon T, Bannuru R, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage. 2014;22:363-88.
  16. Derry S, Conaghan P, Da Silva J, Wiffen P, Moore R. Topical NSAIDS for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2016 Apr 22;4:CD007400
  17. Machado G, Maher C, Ferreira P, Pinheiro M, Lin C, Day R, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of ran-domized placebo controlled trials. BMJ. 2015;350:h12251
  18. Ennis Z, Dideriksen D, Vaegter H, Handberg G, Pottegard A. Acetaminophen for chronic pain: A systematic review on efficacy. 2016;118:184-9.
  19. Canadian Pharmacists Association, SNRIs, e-therapeutics.ca, access February 2, 2017
  20. Cepeda M, Camargo F, Zea C, Valencia L. Tramadol for osteoarthritis: a systematic review and metaanalysis. J Rheumatol. 2007;34(3):543-55.
  21. Cepeda M, Camargo F, Zea C, Valencia L. Tramadol for osteoarthritis. Cochrane Database Syst Rev. 2006;19(3):CD005522.
  22. Cooper C et al. In. Brandt KD, Doherty M, Lohmander LS, eds. Osteoarthritis. Oxford, NY. Oxford University Press, 1998 237-249
  23. Vancouver Coastal Health. Ostearthritis Service Integration System. Manage Your OA. Exercise. http://oasis.vch.ca/manage-your-oa/exercise/, accessed March 3, 2017.
  24. Vancouver Coastal Health. Ostearthritis Service Integration System. Manage Your OA. Joint Protection. http://oasis.vch.ca/manage-your-oa/joint-protection/, accessed March 3, 2017.
  25. Paraffix Wax for Osteoarthritis. : http://www.webmd.com/osteoarthritis/tc/paraffin-wax-for-osteoarthritis-topic-overview#1, accessed March 3, 2017.

Copyright & Disclaimer

CEP fully supports the use of the Osteoarthritis (OA) Tool by providers, educators, decision-makers and others. Please read the following information prior to use of the Tool to ensure appropriate permission is sought and appropriate citation is used.

Creative Commons License

Creative CommonsOsteoarthritis Tool is a product of the Arthritis Alliance of Canada, the Centre for Effective Practice and the College of Family Physicians of Canada. Permission to use, copy and distribute this material for all non-commercial and research purposes is granted, provided that all copies, modifications, and distributions contain full reproductions of this Creative Commons License and the following Disclaimer along with appropriate citation.  Use of the Osteoarthritis Tool for commercial purposes or any modifications of the tool are subject to charge and use must be negotiated with Arthritis Alliance of Canada, the Centre for Effective Practice and the College of Family Physicians of Canada. (Email: [email protected]effectivepractice.org)

For statistical and bibliographic purposes, please notify the Arthritis Alliance of Canada, the Centre for Effective Practice and the College of Family Physicians of Canada ([email protected]) of any use or reprinting of the tool.

Please use this citation when referencing the tool: 

Reprinted with Permission from Arthritis Alliance of Canada, the Centre for Effective Practice and the College of Family Physicians of Canada (June 2017). Osteoarthritis Tool. Canada: Arthritis Alliance of Canada, the Centre for Effective Practice and the College of Family Physicians of Canada.

Disclaimer

The Osteoarthritis Tool (the “Tool”) contains links to websites and other external resources (“Third Party Resources”) that are operated by and/or created by third party organizations.  These third party organizations are solely responsible for the information contained in, and the operation of (as applicable), their respective Their Party Resource(s).

This Tool was developed for licensed health care professionals in Canada as a guide only and does not constitute medical or other professional advice.  Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool.

Neither the Arthritis Alliance of Canada, the Centre for Effective Practice, the College of Family Physicians of Canada, the contributors to this Tool, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by any individual including, but not limited to, primary care providers, or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any of the Third Party Resources, that are owned or operated by third parties, including any information or advice contained therein.