title: National survey on the non-pharmacological modalities prescribed by French general practitioners in the treatment of lower limb (knee and hip) osteoarthritis. Adherence to the EULAR recommendations and factors influencing adherence.
abstract: BACKGROUND
  Guidelines for the treatment of lower limb osteoarthritis (LLOA) include non-pharmacological (NPM) and pharmacological modalities (PM). In France, general practitioners (GPs) are the main prescribers of pharmacological treatment for LLOA but little is known about the non-pharmacological modalities they usually prescribe.
  
  
  OBJECTIVE
  To determine how French GPs prescribe non-pharmacological modalities of LLOA treatment in daily practice.
  
  
  METHODS
  A four-point questionnaire (systematically, frequently, rarely, never) was built to assess the French GPs' opinion regarding the NPM of LLOA treatment (10 questions). The questionnaire was given between April and June 2005 to 3000 GPs, all over the French regions. The percentage reported in this abstract are those of the systematic and frequent responses.
  
  
  RESULTS
  59.2% of the questionnaires (n=1775) could be retrieved. Weight reduction recommendations (76%), joint sparing (71.7%), physical activity development (61.7%), rehabilitation (57.8%), self-exercise (46%) were the more frequently prescribed NPM. Sticks (36%), insoles (35.6%), bed relief (25.4%) and knee bracing (10.5%) were far less regularly proposed. However weight reduction and physical activity development appeared to be the patients less-well observed NPM. The main means used to improve the efficacy of the diet were the support of a nutritionist (74.5%) and the support of the GPs (70.7%) far beyond the support group and familial intervention (both 36,6%). The large majority of GPs considered that a good physical activity was essential (51.7%) or useful (43.3%) to the success of the weight reduction programme. The main recommended physical activities were walking (84.3%), swimming (74.3%), cycling (47%) and water-gymnastics (40.4%). To improve the success of the physical activity development, analgesics were recommended by 93% of GPs, settling up through rehabilitation by 57.4%, support through GPs appointments by 50%. Lastly, 68.4% of GPs recommended a systematic analgesic consumption, since a non-steroidal anti-infammatory drug (NSAID) prescription was proposed by only 30.5%, and NSAID treatment before or after physical activities by 19% and 9.3% respectively.
  
  
  CONCLUSIONS
  This large survey shows that non-pharmacological modalities are frequently prescribed by French GPs in the treatment of LLOA, in addition to analgesic therapy. However, most GPs consider that some of them are difficult to follow in the long term.
authors.affiliation: Department of Rheumatology, Hôpital Lyon-sud, Pierre-Bénite, France. Thierry.conrozier@wanadoo.fr
authors.forename: T
authors.initials: T
authors.lastname: Conrozier
authors.forename: J P
authors.initials: JP
authors.lastname: Marre
authors.forename: C
authors.initials: C
authors.lastname: Payen-Champenois
authors.forename: E
authors.initials: E
authors.lastname: Vignon
mesh_terms: D001510:Bed Rest / Q000706:statistics & numerical data; D003625:Data Collection; D005081:Exercise Therapy; D005602:France; D019983:Guideline Adherence; D006801:Humans; D009983:Orthopedic Equipment / Q000706:statistics & numerical data; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D015431:Weight Loss