DOCUMENT 14 FOI-24/25-0120
Research – Osteoarthritis (OA): Evidence Based Treatments
Brief Evidence based treatments for Osteoarthritis (OA).
Date January 18, 2021
Requester(s) Alicia s47F - personal privacy (Senior Technical Advisor (TAB/AAT))
Researcher Craig s47F - persona (Tactical Research Advisor (TAB?AAT)
Cleared Jane s47F - personal priv (Research Team Leader (TAB)
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The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters.
1 Contents
2 Summary ……………………………………………………………………………………………………………………….. 2
3 What is Osteoarthritis (OA)? …………………………………………………………………………………………….. 2
4 Management and Treatment of OA …………………………………………………………………………………… 3
4.1 Evidence based Guidelines and Standards of Care ……………………………………………………….. 3
4.2 Evidence based Models of Care …………………………………………………………………………………. 4
4.3 Treatment and Interventions …………………………………………………………………………………….. 4
4.3.1 Overview …………………………………………………………………………………………………………. 4
4.3.2 Weight Loss ……………………………………………………………………………………………………… 4
4.3.3 Exercise …………………………………………………………………………………………………………… 5
4.3.4 Multidisciplinary Approach ………………………………………………………………………………… 5
4.3.5 Medication ………………………………………………………………………………………………………. 6
4.3.6 Devices such as braces, walking sticks, and shoe insoles ……………………………………….. 7
4.3.7 Surgery ……………………………………………………………………………………………………………. 7
5 Complementary and Alternative Treatment ………………………………………………………………………. 7
6 References …………………………………………………………………………………………………………………….. 8
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2 Summary
• This document makes substantial use of the following comprehensive research paper: Arthritis Australia. Evidence to support the national strategic action plan for arthritis, 2019.
• A range of evidence-based national and international guidelines and standards of care have been developed to support the timely and effective management of OA
• Evidence based first line treatment strategies for OA involve weight loss, exercise, patient education and self-management support, where a multidisciplinary management approach is taken.
• A variety of medications are used to support OA to increase bone mineral density, manage symptoms such as pain and inflammation, and reduce the risk of fractures.
• Complementary medicines are often used in conjunction with pharmaceuticals or as an alternative to traditional medicines
• Joint replacement surgery is used for severe, symptomatic OA, when first line treatment options fail.
• Although devices such as braces, walking sticks, and shoe insoles, are often utilized in OA treatment, there appears to be little evidence of their effectiveness.
3 What is Osteoarthritis (OA)?
Osteoarthritis (OA) is a chronic condition characterised by the breakdown of the cartilage that overlies the ends of bones in joints. This results in the bones rubbing together, causing pain, swelling and loss of motion. OA usually gets worse over time and commonly affects the hands, spine and joints such as hips, knees and ankles [1].
OA has no specific cause, however several factors contribute to the onset and progression [2], including:
• being female • genetic factors • excess weight • joint misalignment • joint injury or trauma (such as dislocation or fracture) • repetitive joint-loading tasks (for example, kneeling, squatting and heavy lifting).
OA is the most common form of arthritis in Australia. An estimated 2.2 million (9.3%) Australians have this condition, according to the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey. OA represented over half (62%) of all arthritic conditions in 2017–18 [1, 3].
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Although OA affects people of all ages, the prevalence increases sharply from the age of 45 years. 1 in 5 Australians (22%) over the age of 45 have OA. It is most common in adults aged 75 and over, with just over one-third (36%) of people in this age group experiencing the condition [1, 3].
OA is also more common among females than males, affecting 10% of females compared with 6.1% of males (after adjusting for age) [1, 3].
At present, there is no cure for OA and the disease is long-term and progressive. Treatment for OA aims to manage symptoms, increase mobility and maximise quality of life. Treatment options for OA include [4]:
• physical activity • weight management • medication • joint replacement surgery
4 Management and Treatment of OA
4.1 Evidence based Guidelines and Standards of Care
A range of evidence-based national and international guidelines and standards of care have been developed to support the timely and effective management of OA, and particularly, hip and knee OA. These guidelines consistently emphasise that core management of OA should comprise a combination of non-pharmacological and pharmacological interventions, with referral for consideration of surgery only if symptoms are no longer responsive to conservative management [5- 13]. The core recommendations for OA management across these guidelines can be broadly summarised as:
• Diagnosis should be based on clinical assessment alone.
• An individualised self-management plan should be developed based on a comprehensive assessment of symptoms, other health conditions and a psychosocial evaluation.
• Conservative (non-surgical) management involving weight loss, exercise, disease-relevant patient education and self-management support are first-line treatment strategies and are also recommended at all stages of the disease.
• If required, pharmacological therapies should be added to the core treatments.
• Patients should be included in shared decision-making for the development of a personalized pain management program involving treatment options such as exercise, orthotics, psychological and social interventions, sleep interventions, weight management and pharmacological treatments [8]
• Referral for consideration of surgery should be made only when conservative management no longer provides adequate pain relief or maintenance of function.
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4.2 Evidence based Models of Care
Models of care are evidence- and consultation-based frameworks that describe what and how health services and other resources should be delivered to people with specific health conditions. Models of care aim to guide the provision of ‘the right care, delivered at the right time, by the right team in the right place, with the right resources.’ They provide an effective way to embed evidence into health policy and practice and achieve system efficiencies [11, 14].
A number of arthritis-related models of care already exist in some jurisdictions in Australia and are at various stages of implementation. These models have been developed by state-based musculoskeletal clinical networks, which have been identified as an important enabler for the development and implementation of models of care [15]. These models include:
• NSW ACI Osteoarthritis Chronic Care Program (OACCP) Model of Care • NSW ACI Local Musculoskeletal Service (LMS) • Osteoarthritis of the Hip and Knee Service (Victoria) • Victorian Model of Care for Osteoarthritis of the Knee and Hip • WA Inflammatory Arthritis Model of Care • WA Service Model for Community-Based Musculoskeletal Health • WA Elective Joint Replacement Service Model of Care • Model of Care for NSW Paediatric Rheumatology Network • Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (Queensland) • Comprehensive Osteoarthritis Pathway and Musculoskeletal Triage and Assessment Service (Tasmania).
4.3 Treatment and Interventions
4.3.1 Overview
Treatments for OA include:
• Weight Loss • Exercise • Pain Management using medication • Devices such as braces, walking sticks, and shoe insoles • Surgery, if symptoms are no longer controlled with other therapies
Weight loss, exercise, and a multidisciplinary approach to both, are viewed as conservative treatments and interventions. Surgery is regarded as non-conservative [11].
4.3.2 Weight Loss
• For obese people with established OA, weight loss of between 5-10% of their body weight can result in significant pain relief, and this may in turn manifest in improvements in
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mobility, physical function and quality of life [16]. Weight loss greater than 10% achieves even larger improvements in symptoms [17].
• Strategies to support weight loss in people with OA may include informal advice, referral to a dietician for appropriate counselling and structured weight loss programs incorporating dietary changes and/or exercise [18].
4.3.3 Exercise
• There is a large body of evidence in support of exercise for OA, with exercise achieving improvements in knee pain and physical function comparable to those reported from non- steroidal anti-inflammatory drugs [19]. Improvements in pain and function following exercise programs for hip OA have also been shown [20].
• Therapeutic water-based exercise has also been shown to have benefits for patients with lower limb (hip or knee) OA [21].
• Supported self-management and exercise programmes, delivered by health professionals, are feasible in clinical practice and can positively impact symptoms, function and medication use [22-24].
• Information, clear advice about benefits and reassurance from health professionals can encourage greater exercise participation by patients with OA [25].
• Studies of innovative service delivery models for the provision of physiotherapist-supervised exercise management for people with knee OA have found that the use of Skype and telephone coaching is feasible and beneficial [26, 27].
• Use of booster sessions with a physiotherapist can also help improve exercise adherence for older adults with OA and/or back pain [28].
• Specific neuromuscular exercise programs delivered by trained physiotherapists have demonstrated both short and long term improvements in pain, function and quality of life [23].
4.3.4 Multidisciplinary Approach
• Multidisciplinary conservative care programs for OA have been shown to reduce willingness for joint replacement surgery. Most recently, a randomised controlled trial to investigate the effectiveness of total knee replacement plus non-surgical treatments in comparison to nonsurgical interventions alone, found that both groups reported significant improvements in pain, health related quality of life and functional outcomes. Although improvements were greater in the group undergoing joint replacement, two out of three patients eligible for
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total knee replacement who received non-surgical treatment, had still not proceeded to surgery at the two-year follow up [29].
4.3.5 Medication
• Pharmaceutical medicines are normally used in the management of osteoporosis to increase bone mineral density, manage symptoms such as pain and inflammation, and reduce the risk of fractures. The most common pharmaceuticals used for this condition are bisphosphonates, analgesics and synthetic hormones. [30]
• Medicines used to manage arthritis and osteoporosis can be administered in many different shapes and forms. There are topical treatments and ointments used to alleviate inflammation and mild pain, tablets (often the most common) either to modify the symptoms (for example, analgesics) or the disease (for example, bisphosphonates), and injections which are administered directly into the affected joints to lubricate them or to slow disease progression. Types of medications used for arthritis and osteoporosis [30]:
o Non-steroidal anti-inflammatory drugs, or NSAIDs, are used to relieve symptoms of pain, stiffness and inflammation in the muscles, joints and bones. NSAIDs can be selective or non-selective and are commonly used to manage arthritis. Medications within this group include celecoxib, meloxicam, ibuprofen, diclofenac and naproxen.
o Anti-resorptives are a type of medication commonly used in osteoporosis. This group of medicines binds to bone to stop the removal of calcium, assisting in restoring bone density. Common medicines from this group include bisphosphonates such as alendronate, risedronate and other medications like strontium ranelate.
o Analgesics are medications that relieve pain. These types of medications are used to relieve the symptoms of mild, moderate and severe pain. Common medications used to manage arthritis and osteoporosis include paracetamol, tramadol and paracetamol combinations.
• Typically, treatment is limited to the use of analgesic and/or anti-inflammatory medications to manage symptoms until the condition worsens, at which point the patient is referred for a joint replacement [11].
• There is evidence to support a variety of pharmacological treatment options for pain management. Opioids are generally considered of limited use for managing arthritis pain because the clinical benefits appear to be limited, but the risk of adverse events is high [31, 32].
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4.3.6 Devices such as braces, walking sticks, and shoe insoles
Although literature on treatments for OA advise devices such as braces, walking sticks, and shoe insoles, these are not given evidence-based recommendations by national and international guidelines and standards of care.
In 2018 the Royal Australian College of General Practitioners (RCGP) produced the “Guideline for the management of knee and hip osteoarthritis”, with the objective to present the best available, current scientific evidence for OA interventions, covering all interventions other than joint replacement for the hip and knee [13].
With regard to devices such as braces, walking sticks, and shoe insoles, the RCGP either do not recommend their use or are unable to recommend either for or against their use. This is based on low or very low quality of evidence in their research.
4.3.7 Surgery
• Joint replacement surgery is a highly effective and cost-effective intervention for OA when conservative therapies are no longer effective. Hip and knee replacements provide substantial and sustained improvements in pain, physical function and quality of life [33].
• Despite the demonstrated effectiveness of joint replacement surgery, not all patients experience optimal outcomes and, as with all surgical procedures there is a risk of complications. A substantial proportion of patients is unsatisfied or continues to experience persistent pain after total hip replacement (6-27%) and total knee replacement (15-44%) [34, 35].
• As joint replacement prostheses have a limited lifespan, future revision surgery may also be required. In view of these considerations, national and international clinical guidelines recommend that joint replacement surgery should only be offered for severe, symptomatic OA after conservative management strategies have been trialled [36, 37].
5 Complementary and Alternative Treatment
• Complementary medicines are often used in conjunction with pharmaceuticals or as an alternative to traditional medicines. In recent years, evidence-based research regarding the use of complementary medicines has gained more momentum [30].
• Clinical trials for glucosamine and omega 3 for OA have indicated that these medications may be effective in reducing pain, inflammation and stiffness [38, 39]. However there are contradictions between research findings and methodologies that call into question whether these medications are truly effective in controlling the symptoms of OA [39].
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• Statistically, the ABS, National Health Survey: Summary of Results, 2004-05, indicates that complementary medicines were the most common type of medication to be reported for OA. Females were more likely to be report usage than males overall (48% compared to 36%), with the most common complementary medicines used to manage OA being glucosamine (25%) and fish oils/omega 3 (16%) [40].
6 References
-
Australian Institute of Health Welfare. What is osteoarthritis? Canberra: AIHW; 2020
[Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal- conditions/osteoarthritis. 2. Kay Chapman AMV. Genetic factors in OA pathogenesis: Bone; 2012 [Volume 51, Issue 2,:[Available from: https://www.sciencedirect.com/science/article/abs/pii/S8756328211013652?via%3Dihub. 3. Commonwealth of Australia. National Health Survey: First results:Reference period 2017-18 financial year 2020 [Available from: https://www.abs.gov.au/statistics/health/health-conditions- and-risks/national-health-survey-first-results/latest-release. 4. Australian Institute of Health Welfare. Osteoarthritis Canberra: AIHW; 2020 [14/01/21]. Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal- conditions/osteoarthritis. 5. Australian Commission on Safety Quality in Health Care. Osteoarthritis of the knee clinical care standard: Australian Commission on Safety and Quality in Health Care Sydney; 2017 [Available from: https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee- clinical-care-standard. 6. Briggs AM, Page CJ, Shaw BR, Bendrups A, Philip K, Cary B, et al. A model of care for osteoarthritis of the hip and knee: development of a system-wide plan for the health sector in Victoria, Australia 2018 [47]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008674/. 7. Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis 2013 [1125-35]. Available from: https://ard.bmj.com/content/72/7/1125?papetoc=&itm campaign=ard&itm content=consumer&it m medium=cpc&itm source=trendmd&itm term=0-A. 8. Geenen R, Overman CL, Christensen R, Åsenlöf P, Capela S, Huisinga KL, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Annals of the rheumatic diseases. 2018;77(6):797-807. 9. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee 2012 [465-74]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/acr.21596. 10. Stoffer MA, Smolen JS, Woolf A, Ambrozic A, Berghea F, Boonen A, et al. Development of patient-centred standards of care for osteoarthritis in Europe: the eumusc. net-project. Annals of the Rheumatic Diseases. 2015;74(6):1145-9. 11. Arthritis Australia. Evidence to support the national strategic action plan for arthritis 2019 [Available from: https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2019/06/190612- Final Evidence-to-Support-the-NSAPA Word-Refs.pdf. 12. McAlindon TE, Bannuru RR, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and
Research – Osteoarthritis (OA): Evidence Based Treatments Page 8 of 11
Page 8 of 11
FOI-24/25-0120
cartilage [Internet]. 2014; 22(3):[363-88 pp.]. Available from: https://www.sciencedirect.com/science/article/pii/S1063458414000168. 13. The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis 2018 [2nd:[Available from: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the- management-of-knee-and-hip-oa-2nd-edition.pdf. 14. Briggs AM, Towler SC, Speerin R, March LM. Models of care for musculoskeletal health in Australia: now more than ever to drive evidence into health policy and practice 2014 [401-5]. Available from: https://www.aci.health.nsw.gov.au/ data/assets/pdf file/0009/255996/Briggs et al 2014 Aust Health Rev MSK MoC published.pdf. 15. Briggs AM, Bragge P, Slater H, Chan M, Towler SC. Applying a Health Network approach to translate evidence-informed policy into practice: a review and case study on musculoskeletal health 2012 [394]. Available from: https://link.springer.com/article/10.1186/1472-6963-12-394. 16. Bliddal H, Leeds A, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons–a scoping review. Obesity reviews [Internet]. 2014; 15(7):[578-86 pp.]. Available from: https://onlinelibrary.wiley.com/doi/10.1111/obr.12173. 17. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis care & research [Internet]. 2018; 70(11):[1569-75 pp.]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23608. 18. Brosseau L, Wells GA, Tugwell P, Egan M, Dubouloz C-J, Casimiro L, et al. Ottawa Panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight. Physical therapy [Internet]. 2011; 91(6):[843-61 pp.]. Available from: https://academic.oup.com/ptj/article/91/6/843/2735000?login=true. 19. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane database of systematic reviews [Internet]. 2015; (1). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004376.pub3/full. 20. Fransen M, McConnell S, Hernandez‐Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews [Internet]. 2014; (4). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007912.pub2/full. 21. Waller B, Ogonowska-Slodownik A, Vitor M, Lambeck J, Daly D, Kujala UM, et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Physical therapy [Internet]. 2014; 94(10):[1383-95 pp.]. Available from: https://academic.oup.com/ptj/article/94/10/1383/2735524?login=true. 22. Dziedzic K, Healey E, Porcheret M, Afolabi E, Lewis M, Morden A, et al. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. Osteoarthritis and cartilage [Internet]. 2018; 26(1):[43-53 pp.]. Available from: https://www.sciencedirect.com/science/article/pii/S106345841731244X. 23. Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA: D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC musculoskeletal disorders [Internet]. 2017; 18(1):[1-13 pp.]. Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1439-y. 24. Thorstensson CA, Garellick G, Rystedt H, Dahlberg LE. Better management of patients with osteoarthritis: development and nationwide implementation of an evidence‐based supported osteoarthritis self‐management programme. Musculoskeletal care [Internet]. 2015; 13(2):[67-75 pp.]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1085. 25. Hurley M, Dickson K, Hallett R, Grant R, Hauari H, Walsh N, et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane database of systematic reviews [Internet]. 2018; (4). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010842.pub2/full.
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- Hinman R, Nelligan R, Bennell K, Delany C. “Sounds a bit crazy, but it was almost more personal:” a qualitative study of patient and clinician experiences of physical therapist–prescribed exercise for knee osteoarthritis via Skype. Arthritis care & research [Internet]. 2017; 69(12):[1834-44 pp.]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23218.
- Hinman RS, Delany CM, Campbell PK, Gale J, Bennell KL. Physical therapists, telephone coaches, and patients with knee osteoarthritis: qualitative study about working together to promote exercise adherence. Physical Therapy [Internet]. 2016; 96(4):[479-93 pp.]. Available from: https://academic.oup.com/ptj/article/96/4/479/2686489.
-
Nicolson PJ, Bennell KL, Dobson FL, Van Ginckel A, Holden MA, Hinman RS. Interventions to
increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis. British journal of sports medicine [Internet]. 2017; 51(10):[791-9 pp.]. Available from: https://bjsm.bmj.com/content/51/10/791.short. 29. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S, et al. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis and cartilage [Internet]. 2018; 26(9):[1170-80 pp.]. Available from: https://www.sciencedirect.com/science/article/pii/S1063458418312214. 30. Australian Institute of Health and Welfare. Medication use for arthritis and osteoporosis Canberra: AIHW; 2010 [Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal- conditions/medication-use-arthritis-osteoporosis. 31. da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AW, et al. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews [Internet]. 2014; (9). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003115.pub4/full. 32. Whittle SL, Richards BL, Husni E, Buchbinder R. Opioid therapy for treating rheumatoid arthritis pain. Cochrane Database of Systematic Reviews [Internet]. 2011; (11). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003113.pub3/full. 33. Shan L, Shan B, Suzuki A, Nouh F, Saxena A. Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. JBJS [Internet]. 2015; 97(2):[156-68 pp.]. Available from: https://journals.lww.com/jbjsjournal/Abstract/2015/01210/Intermediate and Long Term Quality of Life After.10.aspx. 34. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ open [Internet]. 2012; 2(1). Available from: https://bmjopen.bmj.com/content/2/1/e000435.short. 35. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. PAIN® [Internet]. 2011; 152(3):[566- 72 pp.]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0304395910007086. 36. Harris M, Bennett J, Del Mar CB, Fasher M, Foreman L, Furler J, et al. Guidelines for preventive activities in general practice: The Royal Australian College of General Practitioners; 2009. 37. National Institute for Health and Clinical Excellence Ocam. Osteoarthritis: care and management clinical guideline 2014 [Available from: www.nice.org.uk/guidance/cg177/resources/osteoarthritis-careand-management-35109757272517. 38. Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain [Internet]. 2007; 129(1-2):[210-23 pp.]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0304395907000413. 39. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. Jama [Internet]. 2000; 283(11):[1469-75 pp.]. Available from: https://jamanetwork.com/journals/jama/article- abstract/192498.
Research – Osteoarthritis (OA): Evidence Based Treatments Page 10 of 11
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-
Australian Bureau of Statistics. National Health Survey: Summary of Results, 2004-05 2006
[Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.02004-05.
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