Sports Medicine Research: In the Lab & In the Field: Osteo- Are- We Educated about OA and PTOA? (Sports Med Res)


Wednesday, June 8, 2016

Osteo- Are- We Educated about OA and PTOA?

Certified Athletic Trainers’ Knowledge and Perceptions of Posttraumatic Osteoarthritis After Knee Injury

Pietrosimone BG, Blackburn JT, Golightly YM, Harkey MS, Luc BA, DeFreese JD, Padua DA, Jordan JM, & Bennell KL.  J Athl Train. Published Online First: March 10, 2016. doi: 10.4085/1062-6050-51.2.13

Take Home Message: Athletic trainers are familiar with osteoarthritis, but less familiar with posttraumatic osteoarthritis.  This knowledge seems to come with years of experience in the field. 

We have had many posts on Sports Med Res about the long-term consequences of knee injuries (for example, osteoarthritis). However, many athletic trainers and other healthcare professionals are focused on the current health of a patient (for example, preventing or treating an injury) and neglect long-term health concerns like the early onset of osteoarthritis after an injury (posttraumatic osteoarthritis [PTOA]). The NATA’s initial commitment to the Chronic Osteoarthritis Management Initiative was to “Incorporate OA into education components for early career practitioners; note role of athletic trainers as gatekeepers” but it remains unknown as to whether or not athletic trainers (ATs) are knowledgeable about osteoarthritis and its treatment after knee injury.  Therefore, the authors of this cross-sectional survey study aimed to evaluate the knowledge and perceptions of PTOA in 2000 randomly sampled ATs.  Among 437 (22%) ATs who completed the survey, about 85% correctly identified the osteoarthritis definition; however, only 60% of respondents were familiar with PTOA.  The majority of ATs believed that patients with a history of meniscal injury/surgery or anterior cruciate ligament injury had a greater risk for PTOA but they underestimated the percentage of patients who would develop osteoarthritis in the first decade or two after these injuries.  ATs also overestimated the protective benefits of surgery after an injury. About 70 to 80% of ATs discussed the risk and strategies to mitigate the risk of PTOA with their patients. Only about 40% of ATs felt a patient having knee osteoarthritis was a major health concern. The authors discovered that an AT with more years of experience was more likely to have PTOA knowledge compared with an AT with less clinical experience.  Also, a previous personal history of a knee injury did not increase the percentage of ATs aware of PTOA.

The findings of this study are interesting because these authors confirm that knowledge about the definition of osteoarthritis is relatively good, but that there is still education needed regarding PTOA within an AT population.  It is interesting that there is an increase in PTOA knowledge among ATs with more years of experience.  The assumption being that clinicians may be “picking it up as they go” along in their career based on their experiences or attendance at symposia, and that they are not necessarily learning this in formal education programs.  The findings of this study could help inform athletic training education programs of a need to incorporate PTOA into curricula, similar to the integration of long-term effects of concussions.  It appears that ATs are overestimating the protective nature of ACL or meniscal surgery.  This is interesting because previous research has shown that ACL reconstruction is not protective against the development of PTOA.  Many patients will turn to ATs for guidance after a knee injury, and if the AT is not appropriately educated in this area, it could lead to misinformed decisions and a loss of trust.  It would be interesting to see what the relationship of PTOA knowledge/education is to the use of primary or secondary prevention strategies in the clinical services of the ATs surveyed.  Ultimately, ATs have a general knowledge of OA, but there is more education needed in PTOA.  This will only help the patients that we deal with regularly.

Questions for Discussion:  What are some things you advise your patients after a knee injury?  What do you think are some successful strategies for educating ATs and other sports medicine professions – who are populations who typically do not think about long-term management?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Does anterior cruciate ligament reconstruction lead to degenerative disease?  Thirteen-year results after bone-patellar tendon-bone autograft

Pietrosimone BG, Blackburn JT, Golightly YM, Harkey MS, Luc BA, DeFreese JD, Padua DA, Jordan JM, & Bennell KL (2016). Certified Athletic Trainers' Knowledge and Perceptions of Posttraumatic Osteoarthritis After Knee Injury. Journal of Athletic Training PMID: 27145097


Ryan Duffy said...

Very interesting read. It's surely and uncomfortable conversation to have with an athlete, but an important one. Introducing this in undergraduate and graduate level courses will only help clinicians become more educated and more comfortable with this difficult topic. It is the role of an ATC, as well as any healthcare provider to look after the athlete now and down the road. When athletes are not focused on their future health, it is our role to step in and start the conversation to educate the athlete on the long term effects of their injury or surgical procedure.

Jeffrey Driban said...

Thanks Ryan! I agree that more education and discussions about we can discuss this with our patients is important. We have an obligation to our patients to ensure that they are properly informed about what they may be at risk for and how they can modify that risk.

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