The Chronic Osteoarthritis Management Initiative (COAMI)

Dr. Joanne Jordan, COAMI Chair, worked with colleagues to prepare the U.S.Bone and Joint Initiative (USBJI)/COAMI annotated bibliography of guidelines and recommendations on the management of OA. An extensive literature review and rigorous screening process yielded several areas where current recommendations and guidelines offer general consensus: education and self-management, exercise and weight loss, use of assistive devices, alternative/complementary approaches, surgical interventions, and pharmacologic interventions.

The Findings of the Annotated Bibliography of Clinical Outcomes on the Management of Osteoarthritis team also included TARC team members Kirsten Nyrop, PhD; Amanda Nelson, MD, MSCR; Yvonne Golightly, PT, MS, PhD; Adam Goode, PT, DPT, PhD; and Leigh Callahan, PhD.  Dr. Nelson was the first author of the manuscript.  Kelli Allen, PhD, currently at Duke, was also on the team.

A systematic review of recommendations and guidelines for the management of osteoarthritis: The Chronic Osteoarthritis Management Initiative of the U.S. Bone and Joint Initiative.  Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM.  Semin Arthritis Rheum. 2013 Dec 4. pii: S0049-0172(13)00258-8. doi: 10.1016/j.semarthrit.2013.11.012. [Epub ahead of print]

Access the abstract:  http://www.ncbi.nlm.nih.gov/pubmed/24387819 

Summary Recommendations from a Systematic Review of Recommendations and Guidelines for the Management of OA

  • Provide or refer patients to self-management programs.
  • Provide education, regular contact to promote self-care, joint protection strategies, and individualized treatment plans.
  • Advise patients to engage in low-impact aerobic exercise and, if overweight, to lose weight.
  • Consider range of motion, flexibility, endurance, and strengthening exercises, exercise combined with manual therapy, and PT/OT referral.
  • Recommend walking aids and assistive devices to improve Activities of Daily Living (ADLs).
  • Discuss thermal modalities for hand, knee and hip OA.
  • Joint replacement is recommended for appropriate patients.
  • Arthroscopy with debridement is not indicated for symptomatic OA.
  • Pharmacologic management of OA
  • Intra-articular therapy

Click here to view the COAMI Care Model in it's entirety