Conditional recommendations for the intervention

It may be appropriate to offer CBT for some people with knee and/or hip OA

Clinicians should consider whether CBT is appropriate, taking into account psychological comorbidities and personal preference. They should be cognisant of issues related to cost and access. It is recommended that CBT is combined with exercise to improve outcomes. CBT may be offered face-to-face or via online programs

Conditional for recommendation

Low (knee)
Very low (hip)

It may be appropriate to offer stationary cycling and/or Hatha yoga for some people with knee OA

Exercise has also been found to be beneficial for other comorbidities and overall health

Clinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability and the availability of resources and local facilities. Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur

Attention should be paid to strategies to optimise adherence. Referral to an exercise professional to assist with exercise prescription and to provide supervision either in person or remotely may be appropriate for some people

Conditional for recommendation

Very low

It may be appropriate to offer aquatic exercise/ hydrotherapy for some people with knee and/or hip OA. This will depend upon personal preference and the availability of local facilities

Conditional for recommendation

Low

It may be appropriate to offer a short course of massage therapy for some people with knee and/or hip OA. This should be considered only as an adjunctive treatment to enable engagement with active management strategies, and only for short term, cognisant of issues related to cost and access

Conditional for recommendation

Low

It may be appropriate to offer a combination of weight management plus exercise for some people with knee and/or hip OA. For those who are overweight (BMI ≥25 kg/m2 ) or obese (BMI ≥30 kg/m2 ), a minimum weight loss target of 5–7.5% of body weight is recommended. It is beneficial to achieve a greater amount of weight loss given that a relationship exists between the amount of weight loss and symptomatic benefits. Weight loss should be combined with exercise for greater benefits. For people of healthy body weight, education about the importance of maintaining healthy body weight is essential

Conditional for recommendation (combination weight management plus exercise)

Low (knee)
Very low (hip)

It may be appropriate to offer local heat therapy (eg hot packs) as a self-management home strategy for some people with knee and/or hip OA. This should be considered only as an adjunctive treatment

Conditional for recommendation

Very low

It may be appropriate to offer an assistive walking device (eg cane) for some people with knee and/or hip OA, depending on a person’s preference and capability

Conditional for recommendation

Low (knee)
Very low (hip)

It may be appropriate to offer TENS that can be used at home for some people with knee and/or hip OA. Clinicians need to provide sufficient instructions on selfuse, and consider individual accessibility and affordability

Conditional for recommendation

Very low

It may be appropriate to offer oral NSAIDs for some people with knee and/or hip OA
It might be reasonable to trial oral NSAIDs at the lowest effective dose for a short period, then discontinue use if not effective. Clinicians also need to inform people, monitor and capture adverse events, especially gastrointestinal, renal and cardiovascular, which may be associated with use of NSAIDs

Conditional for recommendation

Moderate

It may be appropriate to offer duloxetine for some people with knee and/or hip OA

Duloxetine currently does not have an indication via the TGA for OA, and should be considered as an investigational medication only. It could be considered for some people with knee and/or hip OA when other forms of pain relief are inadequate

Conditional for recommendation

Moderate (knee)
Low (hip)

It may be appropriate to offer an intra-articular corticosteroid injection for some people with knee and/or hip OA for short-term pain relief Clinicians need to be cautious of the potential harms of repeated use

Conditional for recommendation

Very low