knee pain

For Patients With Nontraumatic Knee Pain, Early Rehabilitation Lowers Odds of Later Use of Opioids, Injections, Knee Surgery

APTA.org – From PTJ

In brief:
  • Retrospective cohort study analyzed Medicare claims data for 52,504 beneficiaries with non-traumatic knee pain (NTKP) to analyze effects of early rehabilitation on later use of drugs, nonsurgical invasive procedures, and surgery
  • Patients receiving rehabilitation were divided into 3 groups: early rehabilitation (within 15 days of diagnosis), intermediate rehabilitation (16-120 days after diagnosis), and late rehabilitation (120 or more days after diagnosis); data were tracked for 1 year after diagnosis
  • Early rehabilitation patients were 33% less likely than non-rehabilitation control to engage in later use of drugs, 50% less likely to receive nonsurgical invasive procedures, and 42% less like to undergo surgery; similar differences were not found in intermediate and late-rehabilitation groups
  • Only 11% of NTKP patients received any rehabilitation at any time; of those who did receive rehabilitation, 52% were in the early group, 27% were classified in the intermediate group, and 21% received late rehabilitation
  • Authors believe results, while preliminary, support the trend toward more widespread use of early rehabilitation as a first-line treatment for NTKP

knee painWhen it comes to rehabilitation of individuals with nontraumatic knee pain (NTKP), authors of a new study concluded that it really is a case of “the sooner the better”—at least when it comes to reducing use of drugs, injection therapies, and surgeries later on.

In a retrospective cohort study that analyzed records of 52,504 Medicare beneficiaries, researchers from the University of Pittsburgh found that patients with NTKP who received rehabilitation within the first 15 days after diagnosis were 33% less likely to use narcotic analgesics over the following year than patients who received delayed or no rehabilitation. Additionally, the early rehabilitation group was 50% less likely to move to nonsurgical invasive procedures such as corticosteroid injections, and 42% less likely to undergo later knee surgery. Results were published in Physical Therapy (PTJ) APTA’s scientific journal.

The study defined rehabilitation as “exercise or other nonpharmacological services or procedures that are recommended as early stage management options for patients with NTKP.” This definition included exercise, nutritional counseling, functional training, physical agents, manipulation, and manual therapy, and was not linked to a particular service provider or setting.

Besides the utilization patterns of early rehabilitation patients, authors of the study were also interested in overall usage of rehabilitation and whether delayed rehabilitation—defined as “intermediate rehabilitation” that occurred 16-120 days after the diagnosis or “late rehabilitation” that took place more than 6 months after the diagnosis—would make a difference in whether or not patients went on to the other interventions.

The findings about rehabilitation prevalence were not surprising: of the 52,504 patients with NTKP, only 11% received early, intermediate, or late rehabilitation—a number consistent with other studies, authors write. Of the 5,852 patients who received rehabilitation, 52% received early rehabilitation, with 27% receiving rehabilitation 16-120 days later, and the remaining 21% having late exposure to rehabilitation.

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“Research shows the sooner you see your PT for knee pain, the less likely you are to need pain medication, an injection, or even surgery. Deep tissue massage and leg strengthening exercises are now known as the cure for non-traumatic knee pain.” -Ben Farmer PT, DPT, CSCS