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Early Rehabilitation Lowers the Odds of Later Use of Opioids, Injections, Knee Surgery for Patients with Nontraumatic Knee Pain

Wednesday, July 12, 2017

Authors of a recent study concluded that when it comes to rehabilitation of individuals with nontraumatic knee pain (NTKP) “the sooner the better” to reduce the use of drugs, injections and surgeries later on.

Researchers at the University of Pittsburgh analyzed the records of 52,504 Medicare beneficiaries in a retrospective cohort study and found that patients with NTKP which received rehab within the first 15 days after diagnosis were 33% less likely to use narcotic analgesics over the following year than patients who received no or delayed rehabilitation. The early rehabilitation group was also 50% less likely to have nonsurgical invasive procedures like corticosteroid injections and 42% less likely to have knee surgery later on. Results can be found in the Physical Therapy APTA’s Scientific Journal.

Rehabilitation in this study was defined as “exercise or other nonpharmacological services or procedures that are recommended as early stage management options for patients with NTKP." This included nutritional counseling, functional training, exercise, manipulation, physical agents and manual therapy.

Authors of the study were also interested in overall usage of rehabilitation and whether delayed rehab (“intermediate rehabilitation” occurring 16-120 days after diagnosis or “late rehabilitation” occurring more than 6 months after diagnosis) would make a difference in whether other interventions were sought out.

Findings of the 52,504 patients showed only 11% received early, intermediate or late rehabilitation and of those 5,852, 52% received early rehabilitation, with 27% receiving rehabilitation 16-120 days later and 21% with late rehabilitation.

Early intervention seems to make a difference compared to intermediate or late rehabilitation and the later use of drugs, procedures and surgery. Patients who received intermediate or late rehabilitation showed the adjusted odds for receiving any of the interventions were actually higher than for those with no rehabilitation. Authors believe that patients with later rehab were experiencing higher levels of pain and disability for longer times than were the early rehab or control groups. It is hard to say for certain though as the data studied did not include data on pain and function which is a gap that "points to the importance of ongoing efforts to link clinical measures with health care service utilization from claims data."

Authors wrote "Our findings would seem to support the recent recommendations that nonpharmacological treatment options, including those delivered by physical therapists, should be considered prior to treatment with narcotic prescription." And carried on to say "Developing strategies to encourage the use of rehabilitation as a first-line treatment for NTKP, as recommended by current guidelines, has the potential to positively impact a large segment of this clinical population."

Source: PT in Motion