GLA:D – Best treatment for Hip and Knee Osteoarthritis

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Best practice guidelines across the world have long been encouraging physiotherapists, doctors, surgeons and other medical professionals to follow some simple and proven practices to manage Hip and Knee Osteoarthritis – Educate the patient about the disease and what causes it, Exercises to improve joint function and health, and Weight Control to reduce loading through the joint and pain.

These approaches, although effective and simple, were never really followed with advice about what exercise, how much exercise, or even what education might do for this populations. The other problem is that, although these recommendations are based on examining ALL the available evidence from large, well designed studies – they are simply not being followed. Encouraging someone who has pain in their hip or knee to exercise more is hard. Exercising with sore knees and hips is hard, and uncomfortable.

Getting someone to sit down for an hour to learn about their Knee or Hip condition is hard.

The current data suggests that more than 2.1 million Australians suffered from Osteoarthritis (as of 2015) and is projected to rise to nearly 2.5million by 2020, and that complaints about hip or knee pain related to this accounted for 7% of all GP visits Australia wide. Of these, 22% are sent for medical imaging (MRI or Xray) despite strong evidence that the result of the scan has next to no correlation with a patients symptoms.

Plenty of people with really bad scans have no pain and normal function, and vice versa, normal scan results with sore, swollen and dysfunctional joints.

• Only 3.2% of patients complaining of Hip and Knee OA are referred for physiotherapy
• 3.7% are referred for ANY form of exercise therapy, despite this consistently outperforming other treatments
• 12% are referred for surgical opinion despite some of the most common surgical techniques being proven no more effective than sham surgery

Image credit Australian Institute of Health and Welfare

So out of frustration with the fact that clinical practice does not follow clinical guidelines, some clever physiotherapists in Denmark (Ewa Roos and Soren Skou) decided to do some good scientific trials to work out “Which exercise approach is best? And how often / long do you need to do it?” They compared all the available evidence and came up with a combination of strength, aerobic, and balance / control exercises. These should be supervised at first, and be performed at least 2-3 times per week for a minimum of 6weeks. This perfomed the best in terms of reduction in pain and increase in function. They then started their own Clinical Trial at several clinics across their country –  hence GLA:D (Good Living with Arthritis : Denmark) was born.

In it’s current form, GLA:D is run as a 12 week program of exercises, with testing to measure function before and after, with follow up at 12 months to see if the benefits are sustained. These results, along with some outcome surveys are registered with the GLA:D Australia registry, who collect data about the program.

• The first six weeks are supervised by a GLA:D certified physiotherapists to ensure that the program is uniformly administered and the tests are standardised, rendering results that can be depended upon. During this first six-weeks (and ideally in the early stages) the participant should attend the two education sessions to learn about the disease process, how to best manage their condition, why exercise is helpful and what to do if soreness gets worse.
• At the completion of this supervised section, the participant is supplied with the simple and inexpensive exercise equipment to continue the program at home for a further six weeks, after which the functional tests and surveys are repeated, and the results then reported.

Over the last few years this program has spread to Canada, China and now Australia and the growing body of data suggests that each country is achieving similar, and impressive, results. 35% reduction in pain (on average), 75% of people remove themselves from surgical waiting-lists.

So if the program is delivering a greater than 30% reduction in pain, then this still means a bunch of people still have pain, right? Well, yes. The interesting thing is that the improvements in the Quality of Life measures are even more impressive than the outcomes for reduction in pain, as the program teaches patients that even exercising with some pain is safe, that a strong knee with some pain lets you get your life back, and so the impact of any ongoing discomfort is drastically reduced. By becoming active and reducing weight, every 1-2kg of weight loss results in 4-8 times less load being experienced by the knee every step, dramatically reducing pain and slowing disease progression.

The initial education sessions are free, with no obligation to sign up to the program. We do allow one or two sessions to be tried first before committing to the whole 12 weeks, just to ensure that the program is right for you.

If you think you’ve had enough of dealing with your sore hip or knee, and your doctor is only giving you medication and referrals, call us for information on the next education session, or book in for your initial assessment and get cracking!