Knee OA workout thresholds for rehab referral

Researchers at the University of Delaware have determined the minimum workout thresholds for patients with knee osteoarthritis that would determine whether a patient should be referred to physical rehabilitation, according to a presentation at the American College of Rheumatology Annual Meeting.

by Will Offit, Healio Rheumatology November 28, 2016

Washington DC — “We previously found that walking 6,000 steps per day was an important benchmark for maintaining physical health in people with knee osteoarthritis (OA),” Daniel White PT, assistant professor in the Department of Physical Therapy at the University of Delaware, said in his presentation. “However, it is still unclear when doctors, rheumatologists and primary care physicians need to refer their patients with knee OA to rehabilitation.”

“One of the most exciting things about the research is that this getting-up-from-a-chair test is something all physicians can do in their office… So taking the time to have them stand up from a chair five times, and if it takes them more than 12 seconds, they might need a referral to rehabilitation such as physical therapy.” MD Magazine

White and colleagues used public data from the Osteoarthritis Initiative, in which steps per day were recorded for 1,790 patients with an accelerometer until a 48-month follow-up visit. At follow-up, physical function was assessed with the following three tests:

• speed in walking 20 meters;
• time to perform a 400-meter walk; and,
• time to perform five sit-to-stand tests.

The researchers calculated cut-off points at 80% specificity for walking at least 6,000 steps per day.

To have at least 80% specificity for walking 6,000 steps per day — below which represents insufficient physical function — the researchers found the following measurements:

• 1.25 meters per second for the 20-meter walk;
• 315 seconds for the 400-meter walk; and,
• 11 seconds for the five STS tests.

“To be honest, one of the most exciting things about the research is that getting up from a chair is something that all physicians can do in their office,” White said. “I’m a physical therapist and some physicians might be nervous about getting patients in the hallway and timing them and having them fall, but getting up from a chair is fail-safe. If they are going to fall, they will fall right back into the chair.”

Source Healio Rheumatology

References

Minimum Physical Function Needed to Walk 6000 Steps/Day in People with Knee Osteoarthritis, [abstract] Hiral Master, Louise Thoma, Meredith Christiansen, Emily Polakowski, Laura Schmitt and Daniel White. Arthritis Rheumatol. 2016; 68 (suppl 10). 2016 ACR/ARHP Annual Meeting 2016

Prospective change in daily walking over 2 years in older adults with or at risk of knee osteoarthritis: the MOST study, White DK, Tudor-Locke C, Zhang Y, Niu J, Felson DT, Gross KD, Nevitt MC, Lewis CE, Torner J, Neogi T. Osteoarthritis Cartilage. 2016 Feb;24(2):246-53. doi: 10.1016/j.joca.2015.08.004. Epub 2015 Aug 28. PDF

Also see
Despite Disease, Knee Osteoarthritis Patients Can Still Walk 6,000 Steps Per Day MD Magazine
Physical therapy helps manage pain The Fremont Tribune
“A Joint Operation”: Rheumatologists, Orthopedists Collaborate to Improve Patient Outcomes MD Magazine