Funding for Physiotherapy as a first line treatment - Would the UK consider this step?exercise
Osteoarthritis (OA) is a debilitating and painful condition affecting more than 2.2 million Australians at a cost to the health system of $2.1 billion annually. As Australia’s population ages and obesity rates climb, this figure is expected to grow to more than 3 million by 2030.
Common treatment options to date have included opioid prescriptions for pain relief and knee surgery, yet there are significant limitations and dangers associated with these options, including drug dependency and misuse as well as complications and delayed recovery from surgery.
As evidence grows to support physiotherapy and targeted exercise program interventions for OA management, the Australian Physiotherapy Association (APA) is calling on the federal government to fund physiotherapy as a first line treatment option.
APA National President Phil Calvert says the health system needs to offer better value by providing a range of treatment options which are proven to be effective. “Physiotherapists work with patients who suffer acute and chronic pain every day, so we know that early intervention physio treatment, targeted exercises and proper health education leads to beneficial outcomes for them. But to really address the issue of OA management on a national scale we need MBS reform, specifically a new service item descriptor that allows direct-to-physio referrals for patients with any type of arthritis. This should be the first line treatment, not opioids or surgery.”
“Patients should - and increasingly want to be - active participants in their own health decisions, and while short term opioid prescriptions may be a part of the solution for OA management, they are definitely not the only solution. Numerous studies have shown that preventive physiotherapy treatment works, and it is also far less costly to the health system.
“When compared to the longer-term issues associated with opioid use and addiction, and the enormous cost of knee surgeries which are not the silver bullet many patients hope they will be, it makes sense that the government funds a simpler, cheaper and more effective option. It is a win-win for patients and the health system to fund physiotherapy for OA management.”
This funding is particularly critical for physiotherapy services in rural and remote Australia, where patients are often prescribed opioids because specialist health services are relatively scarce and difficult to access.
The recently released RACGP guidelines for the management of knee and hip OA also support the use of non-drug treatments for pain relief, with a specific recommendation to GPs to engage a physio early in a patient’s treatment plan. The guidelines strongly recommend offering tailored exercises for all people with knee and hip OA to improve pain and function, regardless of their age, disease severity or pain levels. Exercise has also been found to be beneficial for other comorbidities that OA patients often present with such as diabetes and cardiovascular disease.
APA physiotherapist Dr Christian Barton, an OA researcher at LaTrobe University, says “One of the biggest problems we have to address is that many people are told to rest when they have pain, rather than stay active. As a result they often become quite sedentary, which can lead to depression, weight gain and an increased risk of other chronic diseases.”
“Proper exercises, regular physical activity and good health education are essential for OA management, all of which can be delivered by exercise specialists like physios. The missing link is the funding to provide patients the opportunity to do this.”
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Ackerman, I.N., Zomer, E., Gilmartin-Thomas, J.F.M., Liew, D. (2017). Forecasting the future burden of opioids for osteoarthritis. Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2017.11.001
Bennett, C. (2018). Understand pain to prevent Aussie opioid crisis. The Daily Telegraph, June 26, 2018.