Perspectives on the management strategies of osteoarthritis knee among various care-takers: A delphi study

Introduction: To achieve a consensual perception from various care-takers involved in the management of osteoarthritis (OA) knee in routine clinical practice. Methods: A two-round Delphi method was used to achieve consensus. Ayurveda/yoga/naturopathy physicians, general practitioners, orthopedicians and rheumatologists and physiotherapists - 4 specialist groups involved in management of OA patients were invited to participate. Questionnaire was developed based on expert opinion and a coherent perception was derived from two Delphi rounds. Response was analyzed using pre-established criteria. Consensual perception with overall final average ≥60% agreement was accepted in each Delphi round for defining the management strategy. Results: Sixteen out of 25 statements were accepted. Three statements were accepted in the first round and one was rejected as it had ≤20% agreement. Thirteen were accepted in second round and no agreement could be reached for 8 questions. The response rate in first round was 20.48% and in second round was 44.66%. All statements on grading and treatment approach and surgical intervention reached coherence in perception between 60-80%. Forty-three percent of the statements regarding drug therapy and 80% of the statements in allied management strategies were accepted. But no concurrent perception could be reached on diagnostic procedures. Conclusion: In the first ever Delphi exercise, consensus on perception of care-takers was noted in many of the focus areas in management of OA knee. Discussions and recommendations are needed on advice of analgesics, steroids and pharmacotherapy for management of severe pain. The implementation of the operational definition in diagnosis of osteoarthritis requires further research/guidelines.