Physiotherapists and pharmacists can help reduce knee pain and reliance on painkillers

Pragmatic randomized clinical trial of the effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in older people presenting to primary care

Older people with knee pain who receive their main care from physiotherapists and pharmacists are more likely to experience improvements in pain levels and knee function, and are less likely to need NSAIDs (non-steroidal anti-inflammatory drugs, eg asprin and ibuprofen), according to a BMJ study.

Researchers from Keele University undertook a study involving over 300 people with knee pain. The participants (aged over 55), were split into three groups.

The first group took part in an 'enhanced pharmacy review' with up to 6 appointments with an experienced community pharmacist to monitor the appropriateness and effectiveness of medication. A second group received up to 6 sessions with a physiotherapist, which included general aerobic exercise and specific muscle strengthening and stretching exercises. A final 'control' group received an information and advice leaflet – which was also issued to the other two groups – plus a telephone call to reinforce the information in the leaflet and address any specific concerns about putting the advice into practice.

When compared with the control group, those in the physiotherapy group reported a significant improvement in pain levels and in knee function after three months of treatment. Participants in the pharmacy group also reported improvements in pain levels.

However, in the longer term (at six months and 12 months), there were no significant differences in pain or function between the physiotherapy, pharmacy and control group. The researchers suggest that this change may in part be due to a lack of adherence to the programme – as time goes by people may not be as strict about keeping up with their exercise programme or taking their medication.

However, there were differences between each groups' usage of NSAIDs (non-steroidal anti-inflammatory drugs, e.g. asprin and ibuprofen). The study found that participants in the pharmacy and physiotherapy groups were less reliant on NSAIDs than the control group. At six months NSAID usage was 16% lower in the pharmacy group and 15% lower in the physiotherapy group than those in the control group, with no increase in pain reporting and high levels of patient satisfaction. The researchers say that this finding has 'important safety implications' as NSAIDs can cause adverse reactions and illness, and are not recommended for long-term use, particularly for older people.

The study also found that physiotherapy appeared to encourage a long-term shift in behaviour away from GP led care – with participants in the physiotherapy group less likely to consult their GP about knee pain than patients in the control group.

The authors conclude that further investigation is needed to how the early clinical benefits of physiotherapy and pharmacy can be sustained in the long-term.'

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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