title: Treatment of knee pain in older adults in primary care: development of an evidence-based model of care.
abstract: OBJECTIVE
  To develop a stepped model of care for the treatment of knee pain in older adults in primary care based on recommended interventions.
  
  
  METHODS
  A systematic search was undertaken to identify interventions recommended for knee osteoarthritis or knee pain in clinical guidelines and systematic reviews. Following this, a nominal group consensus exercise was conducted with members of the Primary Care Rheumatology Society to allocate the interventions to a stepped model of care.
  
  
  RESULTS
  Twenty-seven recommended interventions were identified from 77 publications following the systematic search. A four-step model of care incorporating these interventions was developed through the consensus exercise. Step 1 comprised ten interventions that should be offered to all older adults with knee pain, but could also be provided through self-care. These included exercise, weight loss, paracetamol and written information. Steps 2 and 3 comprised 10 and 6 interventions, respectively, to be considered for people with persisting pain and disability. These included pharmacological interventions such as non-steroidal anti-inflammatory drugs in step 2 and intra-articular corticosteroids in step 3, and non-pharmacological interventions such as physiotherapy in step 2 and occupational therapy in step 3. Step 4 was referral for surgery.
  
  
  CONCLUSIONS
  Previous evidence-based guidelines for the treatment of knee problems have been developed in secondary care. A systematic search for recommended interventions, and a consensus exercise, has now enabled an evidence-based and practical model of care for knee pain in older adults to be developed for use in primary care.
authors.affiliation: Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Keele, Staffs ST5 5BG, UK. m.porcheret@keele.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Porcheret
authors.forename: K
authors.initials: K
authors.lastname: Jordan
authors.forename: P
authors.initials: P
authors.lastname: Croft
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration; D019317:Evidence-Based Medicine; D006801:Humans; D007719:Knee Joint; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*