Treatment of knee pain in older adults in primary care: development of an evidence-based model of care

M. Porcheret, K. Jordan, P. Croft in collaboration with the Primary Care Rheumatology Society

The objective of this study was to develop a stepped model of care for the treatment of knee pain in older adults in primary care based on recommended interventions.  A systematic search was undertaken to identify interventions recommended for knee osteoarthritis or knee pain in clinical  guidelines and systematic reviews. Twenty-seven recommended interventions were identified from 77 publications following the systematic search. A four-step model of care incorporating these interventions was developed through the consensus exercise. Step 1 comprised ten interventions that should be offered to all older adults with knee pain, but could also be provided through self-care. These included exercise, weight loss, paracetamol and written information. Steps 2 and 3 comprised 10 and 6 interventions, respectively, to be considered for people with persisting pain and disability. These included pharmacological interventions such as non-steroidal anti-inflammatory drugs in step 2 and intra-articular corticosteroids in step 3, and non-pharmacological interventions such as physiotherapy in step 2 and occupational therapy in step 3. Step 4 was referral for surgery. 

Rheumatology 2007 46(4):638-648

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Neck Pain

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.

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