Quality standard

Quality statement 7: Core treatments before referral for consideration of joint surgery

Quality statement 7: Core treatments before referral for consideration of joint surgery

Quality statement

Adults with osteoarthritis are supported with non‑surgical core treatments for at least 3 months before any referral for consideration of joint surgery.

Rationale

Core treatments for adults with osteoarthritis are verbal and written information to support a better understanding of the condition, tailored therapeutic exercise and weight management for people who are also living with overweight or obesity. Core treatments support the person to self‑manage their condition and help to relieve symptoms. It is therefore important that these treatments are tried before a surgical solution is explored. Ensuring that core treatments are tried first will help to reduce unnecessary referrals. People who do go on to have surgery are likely to have improved outcomes if core treatments are undertaken pre‑operatively.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults with osteoarthritis are supported with non‑surgical core treatments for at least 3 months before any referral for consideration of joint surgery.

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications.

Process

Proportion of adults with osteoarthritis referred for consideration of joint surgery who were supported with non‑surgical core treatments for at least 3 months.

Numerator – the number in the denominator who were supported with non‑surgical core treatments for at least 3 months.

Denominator – the number of adults with osteoarthritis referred for consideration of joint surgery.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (GPs, community healthcare providers and hospitals) ensure that policies and processes are in place so that adults with osteoarthritis are not referred for consideration of joint surgery until they have been supported with non‑surgical core treatments for at least 3 months.

Healthcare professionals ensure that they do not refer adults with osteoarthritis for consideration of joint surgery until the person has been supported with non‑surgical core treatments for at least 3 months.

Commissioners ensure that they commission services in which adults with osteoarthritis are not referred for consideration of joint surgery until they have been supported with non‑surgical core treatments for at least 3 months. Commissioners should consider audits of people referred for consideration of joint surgery to ensure that the patient record shows that they were supported with core treatments for at least 3 months before referral.

Adults with osteoarthritis are given information, and are advised and supported to exercise and (if appropriate) lose weight to help with joint pain and stiffness, for at least 3 months before any referral for possible joint surgery.

Source guidance

Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226 (2022), recommendations 1.2.2 and 1.6.1, and expert opinion

Definitions of terms used in this quality statement

Core treatments

Core treatments for osteoarthritis include:

  • explanation and ongoing advice and information about the condition and its management

  • therapeutic exercise, tailored to the adult's individual needs, for example, local muscle strengthening and general aerobic fitness

  • weight management (if appropriate).

[Adapted from NICE's guideline on osteoarthritis in over 16s, recommendations 1.2.2, 1.2.3, 1.3.1 and 1.3.2]

Support with non‑surgical core treatments

Healthcare professionals will need to make a judgement about the best way to encourage people to participate in exercise, because this will vary for each person depending on their needs, circumstances and self‑motivation, and may change over time. Support to increase physical activity and encourage participation in tailored therapeutic exercise will include advice and information, and may include information about local services such as physiotherapy or exercise classes, groups and facilities.

Support to help someone with osteoarthritis to lose weight should focus on multicomponent interventions, and may also include pharmacological and surgical interventions. The level of support should be determined by the person's symptoms and needs, and be responsive to changes over time. Weight management programmes should be delivered by a trained professional. They should include behaviour change strategies to increase physical activity and encourage healthy eating. [Adapted from NICE's guideline on osteoarthritis in over 16s, recommendations 1.2.2, 1.2.3, 1.3.1 to 1.3.3 and 1.3.5; NICE's guideline on obesity: identification, assessment and management, recommendations 1.2.15, 1.2.16, 1.2.28, 1.2.29, 1.4.1, 1.4.4, 1.8.8, 1.10.1, 1.10.2; and expert opinion]

Equality and diversity considerations

Healthcare professionals should take into account cultural and communication needs (including any learning disabilities) when providing information and support for adults with osteoarthritis. This should include providing printed information for people who cannot access information online and providing information in accessible large print and easy read formats where needed.

All adults with osteoarthritis should be encouraged to exercise. If age, comorbidities, pain severity or disability are seen as a barrier, the person may need specific advice and support (such as supervised therapeutic exercise) to encourage participation, and should be advised that exercise may improve their symptoms.

When referring adults with osteoarthritis to a weight management service, any potential difficulties in accessing services, which may include distance, disability and financial obstacles, should be taken into account.