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 Luke.Schultz@ncahs.health.nsw.gov.au

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 evan.bryant@ncahs.health.nsw.gov.au