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How to Solve Chronic Joint Pain and Cut MSK Costs

19.03.20

Osteoarthritis (OA) affects a growing number of people and as of today, more than 30 million US adults are affected. In fact, it is one of the leading causes of disability in the world – something that will have an increasing effect on healthcare in the future. And without thorough knowledge about the disease and how it can be treated – as well as a clear plan of action – the healthcare industry will face even higher costs related to chronic joint pain. 

In this article, you will read more about the current problems, and learn about clinically proven solutions available today.

Osteoarthritis: The Impact on Individuals and Society

People with OA can experience symptoms such as stiffness, pain, and reduced physical function in affected joints. All of these symptoms are factors that can significantly reduce quality of life. 

But it is not only bad news for individuals. OA treatment, particularly total joint replacements, also results in high costs for society as a whole – especially for health plans, health systems, and employers.

OA treatment in the past, present – and future

For a long time, OA treatment has focused on the structural changes in the joint. However, research shows that the changes that can be seen on x-ray, aren’t necessarily a good way to determine the severity of the disease or the patients’ symptoms. Therefore, the scientific consensus is that the diagnosis should be set clinically. Also, the treatment should be focused on reducing symptoms with the help of exercises, education, and lifestyle changes – rather than structural changes in the joint.

“The treatment should be focused on reducing symptoms with the help of exercises, education, and lifestyle changes – rather than structural changes in the joint.”

Despite national and international guidelines, OA is more than often treated with high-risk measures that, in some cases, cause more harm than good. Each treatment decision is a matter of evaluating the clinically relevant outcome for the patient in relation to costs – and invasive treatments are generally costly alternatives.

A Selection of Such High-Risk Treatments:

  • Arthroscopies (Keyhole surgery of joints)
  • Corticosteroid injections (Anti-inflammatory injections)
  • Viscosupplementation (Hyaluronate injected into the knee joint)
  • PRP (Platelet-Rich Plasma) (Injections of a concentrate of a patient’s own platelets to accelerate the healing of joints)
  • Opioids (Drugs that act on the nervous system to relieve pain)
  • Analgesic medication (For example ibuprofen or diclofenac) 
  • Total joint replacement (A surgery in which parts of an arthritic or damaged joint are removed and replaced with a prosthesis)

What Does the International Guidelines Say?

The recommended first-line OA treatment is a combination of arthritis education and structured land-based exercise programs – with or without weight management. And although this type of treatment may not affect the structural radiographic changes, it is scientifically proven to improve physical function, increase quality of life, and reduce OA-related pain. In addition, it is cost-effective.

“The recommended first-line osteoarthritis treatment is a combination of arthritis education and structured land-based exercise programs.”

The Right Treatment at the Right Time

Personalized, structured exercise works to decrease chronic joint pain: it strengthens the muscles surrounding the affected joint. It means that the muscle can unload some of the strain that would otherwise have been placed on the joint.

Also, the cartilage cells are stimulated to produce molecular building blocks to repair itself, as it is nourished by the synovial fluid (fluid found in the cavities of synovial joints) that seeps into the cartilage tissue during movement. In addition, the patient re-learns their loading patterns, meaning that they can move in a way that is better for the joints. Therefore, offering patients first-line OA treatment – instead of directly providing more or less high-risk solutions like medication and joint replacements – is often more effective for the patient. 

Patients with extreme pain may have difficulty performing exercises. For those – medications, injections, and other treatments could be viable. The same goes for people in need of a total joint replacement. What is important is to not see surgery as first-line treatment, but rather see it as a necessity – if nothing else, like exercise, works.

Solution: The Swedish Solution

Over ten years ago, Sweden implemented a method of first-line treatment based on information, exercise, and weight control: A method that is proven to decrease the patient willingness for total joint replacements, and without negative side effects.

Sweden is probably the only country in the world where total joint replacements have not continually increased since 2009. The national guidelines of OA management in Sweden align with recommendations from OARSI (Osteoarthritis Research Society International).

“Sweden is the first country in the world where total joint replacements have not continually increased since 2009.”

These are implemented in so-called “OA schools”, (self-management programs) that are increasingly available all over Sweden since 2008. These “schools” –including information, exercise, and weight control, led face-to-face by an occupational therapist or physical therapist – are a part of the healthcare system and are offered as a treatment to patients with OA.

Treating Chronic Joint Pain From Home

To make this method more accessible, Joint Academy offers a digital version of an “OA school”, thus a digital clinic, for patients to treat hip and knee pain from home. The treatment is offered through an app, where each patient gets physical therapy, education, and support from a licensed physical therapist – in accordance with international guidelines.

How to Cut Costs and Boost Outcomes With Digital Clinics

Digital clinics come with several benefits – for both patients, medical professionals, and society. For example, the digital format means that:

  • It is easier to send daily reminders
  • The treatment is available whenever and wherever the patient needs it
  • The medical professionals is always on hand
  • The patient’s progress is automatically logged in the app
  • It’s faster and smoother to update than face-to-face treatment, meaning that it’s easier to stay up to date with current guidelines

Digital clinics also have the potential to make healthcare more available, scalable, and efficient, and they are especially well-suited for chronic conditions, such as OA.

“Digital treatment is a scalable option that saves resources in the traditional healthcare system by making sure that every patient gets the best available first-line treatment – directly.”

In terms of costs, digital treatment is a scalable option that saves resources in traditional healthcare by making sure that every patient gets the best available first-line treatment directly – without expensive detours. Digital OA treatment also holds the potential to reduce the number of total joint replacements , meaning that more money, and lives, is saved. In addition, the amount of sick-leaves and early retirements can be expected to decrease.

To Summarize:

OA has a significant impact on individuals and society alike – with people getting total joint replacements, even if it could have been prevented. This leads to healthcare systems being put under unnecessary stress while losing a lot of money. 

But there is a solution to the problem. By providing a digital first-line OA treatment – including exercise and education – as a standard, a lot of patients can treat their OA, advantageously from home, and avoid future problems connected to chronic joint pain. And healthcare providers offering the right treatment to the right patient – starting with first-line treatment – will be able to cut costs, boost outcomes, and treat more OA patients.