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By Kate Hunger

Physical Therapy Assistant Professor Gustavo Almeida, PT, Ph.D., co-authored an article accepted for publication in Arthritis Care and Research that shows an increase in physician prescriptions for medication and a decrease in physical therapy referrals and lifestyle counseling for patients with knee osteoarthritis. 

The article, "Recommendation rates for physical therapy, lifestyle counseling and pain medications for managing knee osteoarthritis (KOA) in ambulatory care settings: a cross-sectional analysis of the National Ambulatory Care Survey (2007-2015)," published in October ahead of its anticipated winter publication in the printed journal.

In their analysis of data from the National Ambulatory Medical Care Survey, housed in the Centers for Disease Control, Almeida and fellow researchers Samannaaz Khoja and Janet Freburger of the Department of Physical Therapy in the School of Health and Rehabilitation Science at the University of Pittsburgh, studied 2,297 visits to physicians related to knee osteoarthritis. The visits occurred between 2007 and 2015. The studied visits represent a weighted 67 million visits.

“We found that physicians, rather than refer to PT or any behavioral intervention like exercise or weight loss are prescribing pain medication for patients with osteoarthritis,” Almeida said.

The researchers found that the rate of physical therapy referrals by orthopedists fell from 158 per 1,000 visits to 88 per 1,000 visits, and those lifestyle recommendations by orthopedists declined from 184 out of 1,000 visits to 86 out of 1,000 visits.

Meanwhile, the researchers found that prescriptions for non-steroidal anti-inflammatory (NSAID) medications by orthopedists increased from 132 per 1,000 visits to 278 per 1,000 visits, while prescriptions by orthopedists for narcotics increased from 77 per 1,000 visits to 236 per 1,000 visits. 

The researchers’ analysis of primary care visits showed no rate changes for physical therapy referrals, lifestyle recommendations or narcotics prescriptions but did reveal an increase in NSAID prescriptions from 221 per 1,000 visits to 498 per 1,000 visits.

“We know how much physical activity and exercise help people,” Almeida said. “I hope the physicians will see this data and see that they are missing referring to PT or exercise intervention and how bad this is for patients taking medications all the time.”