Cracking the myths of osteoarthritis treatment:
Why exercise, not surgery, should be the first step
Some 2.2 million Australians, or 1 in 4 people over 55 live with knee or hip osteoarthritis. Within 15 years, this figure will reach 3.1 million. Osteoarthritis is the 14th highest cause of disability and rising, costing $4.3 billion annually in healthcare expenses alone, with joint replacement surgery responsible for over 80% of this figure.
Surgery is ‘no silver bullet’
As much as 83% of joint replacement surgeries for osteoarthritis could be delayed, or avoided, if patients choose to swap surgery with non-surgical care – education, exercise and weight management.
“Almost half still report pain years after surgery,” says Dr Felicity Braithwaite, Research Fellow from the University of South Australia.
“Plus, four in five feel they weren’t properly informed about other treatment options before surgery.”
Myths about osteoarthritis mean more are going under the knife
Prevailing societal myths about the best ways to manage osteoarthritis are partly responsible for why many Australians choose to go under the knife, says Dr Braithwaite.
“These misconceptions are widespread among consumers, clinicians, family and friends, and in the media.”
“People living with OA told us about a huge number of misconceptions around osteoarthritis that are still rampant. People perceive, for example, that the joint is ‘bone on bone’, and that surgery is the only solution for OA.”
“Other examples of myths they expressed were “exercise causes more wear and tear”, and “when a joint is bone on bone, it needs surgery”.”
Uptake of core management strategies is poor
Despite being best practice for osteoarthritis, education, exercise and weight loss are still poorly adopted.
“Many people — over half — never try exercise therapy. And only one in three attempt weight loss before having surgery. Surgery rates are projected to rise 276% by 2030 compared with 2013.”
Dr Braithwaite sats these patterns reflect a deep gap between research and real-world practice — a translation problem.
“We need to stop thinking of surgery as the only option for OA,” says Braithwaite. “The real treatment gap isn’t access to surgery. Rather, it’s a lack of awareness or belief in the proven strategies. These beliefs are stemming from almost everywhere, including healthcare providers, and via public information such as websites and the media. Further, general practitioners are referring to surgeons three times more often than non-surgical care.”
Pain education, science and storytelling
Dr Braithwaite is co-designing fun, educational myth busting videos to help educate the public about osteoarthritis. This series of myth busting messages and campaigns are being co-designed with consumers, clinicians, pain organisations, and marketing experts.
“It is important to teach people that there are alternatives to surgery — and the best way to do this is through using the consumer voice so that the messages are believable, meaningful, and not stigmatising.”
Codesigning consumer campaigns to tackle myths head on
As part of a three-year project generously funded by The Hospital Research Foundation-Arthritis, a consumer advisory panel of 10 people with hip, knee, foot and ankle OA was formed.
“We partnered with these consumers as ‘co-researchers’ to decide how best to use the grant funding. We asked them what they saw as the biggest barriers to best practice management of osteoarthritis, and their suggested solutions. The co-researchers came up with the idea that a society-wide media campaign is needed to tackle misconceptions about OA and best-practice management.”
Dubbed ‘mainstreaming osteoarthritis’, the campaign is aimed at reducing the negative impacts of common unhelpful misconceptions. The advisory panel identified seven key myths to tackle, co-designing educational videos for each myth for future campaigns.
Results are showing promise
“So far, we have co-designed a series of brief videos including informational animations as well as testimonials from real people with OA telling their success stories with best-practice management.”
Early results from pilot testing indicate these videos are already showing promise: a single viewing of one of the educational videos significantly improved osteoarthritis beliefs in consumers, clinicians and the wider public. It also improved the intention to exercise in people with OA, with 24% saying they were less likely to see a surgeon in the next year1.
Coming soon: a nationwide media campaign
A future nationwide media campaign is the next goal, according to Dr Braithwaite.
“We are developing educational content that we have co-designed with consumers, using contemporary market research techniques to optimise campaign messages for maximum impact across a broad cross-section of society.”
Explore osteoarthritis myths in the paper titled “Osteoarthritis consumers as co-researchers: identifying consumer insights to improve osteoarthritis management by co-designing translational research solutions”, co-authored with six members of the consumer advisory panel here:
https://pubmed.ncbi.nlm.nih.gov/36924920/
Dr Felicity Braithwaite is a 2024 SA Young Tall Poppy recipient