Sian Crinson, Heather McLintock and Yvonne Rimmer
Betsi Cadwaladr University Health Board
Project Background:
Osteoarthritis ranks highest in the top five causes of disability. It is estimated that approximately 1 in 5 adults, living in the UK, over the age of 45 years have osteoarthritis of the knee and it is predicted that 1 in 2 people will suffer from osteoarthritis within their lifetime.
Orthotic management for osteoarthritis of the knee includes braces worn to support the knee joint directly or alter a person’s lower limb biomechanics to aid symptom management. Numerous studies have shown this results in improved pain scores, with decreased reliance on analgesia, and improved functional outcome measures when used for a period of six months or more.
Currently patients with unicompartmental knee OA have to wait to see an Orthopaedic surgeon to be assessed for suitability for an offloading knee brace across BCUHB (East and Centre), with Orthopaedics also then supplying, fitting and monitoring the patient’s response. There is currently no provision in West area.
Project Aims and Objectives:
With significant delays in accessing an Orthopaedic review (over a year to see an Orthopaedic surgeon) the aim of the new pathway is to:
- Improve access to specialist advice and application of an offloading knee brace.
- Reduce the waiting time for an Orthopaedic review.
- Reduce the number of inappropriate referrals to Orthopaedics.
- Authorise prescribing of offloading knee braces.
- Improve patient outcomes and satisfaction.
Project Outcomes:
A revised process for the provision of offloading braces, implementing earlier decision-making in the form of a virtual MDT through a piloted initiative. This streamlined the previous approach, with reduced waiting times for patients, fewer appointments and reduced associated costs with improved use of resources.
Project Impact:
In total, 11 patients were involved in the 6/12 pilot pathway. The implementation of a virtual MDT reduced the time taken from having an initial consultation in CMATS to receiving an Orthopaedic opinion from 12 months to an average wait of 1.6 months (Range: 1/7 to 3/12).
Despite issues with booking appointments for the fitting of braces in ESP Orthopaedic clinics, for those patients who were booked according to the pilot protocol, the average wait from being discussed at the MDT and recommended for a knee brace, to being seen in the ESP Orthopaedic clinic for the fitting of a knee brace was 3.9 months. Patients reported statistically significant reductions in pain outcome measures and Oxford Knee Scores following fitting of the brace.
Conclusions:
The implementation of a virtual knee MDT supports earlier decision-making and improves more timely access to offloading knee braces for patients diagnosed with unicompartmental knee OA.
This also has implications for Orthopaedic waiting lists, improving conversion rates, making better use of resources and improving patient outcomes.
