Pos0008-Pare Patients’ and Healthcare Professionals’ Perceptions on Weight Reduction in the Treatment of Knee Osteoarthritis

Background: Osteoarthritis (OA) is the most prevalent form of arthritis and OA of the knee is among the most common and functionally limiting forms of the disease. Interventions such as physiotherapy, exercise, and weight reduction when appropriate are recommended as first-line treatments for knee OA. Weight reduction has potential beneficial effects on multiple pathways involving OA symptoms and progression, but effective utilization is limited. Objectives: A systematic literature review was performed to understand patient and healthcare professional (HCP) perceptions of weight reduction in the treatment of knee OA symptoms and progression. Methods: Embase, MEDLINE, CENTRAL, Cochrane Database of Systematic Reviews, and PsycInfo databases were searched for peer-reviewed articles published in English from 2010 to 2023. We included clinical trials and observational studies in which patient or HCP perceptions of weight reduction (via diet, physical activity, anti-obesity medications, or bariatric surgery) related to knee OA were reported. Results: Thirty studies (28 observational studies and two clinical trials) were included. The studies investigated patient perceptions (n=19), HCP perceptions (n=5), or both (n=6). Sample sizes and publication quality varied widely. Most patient studies reported on barriers to achieving weight reduction, and there were few studies incorporating patient or HCP expectations of what weight reduction would achieve in terms of impact on knee OA symptoms and progression. Four themes emerged for patients and HCPs (Figure 1). OA-specific barriers to weight reduction included pain as a barrier to exercise and fear of injury or falling and further damaging the joint. Some HCPs also cited fear-avoidance behaviors that lead to reduced physical activity as patients become convinced that physical activity will cause further damage. Limited knowledge was another theme, with patients expressing lack of understanding of the role of weight reduction in knee OA, lack of understanding of obesity as a disease, and lack of awareness of treatment options for knee OA. HCPs often felt they had insufficient knowledge of weight reduction through diet and physical activity interventions, and facilitating behavior change for OA management. They were concerned about patients receiving incorrect information from friends, family, and media. Non-OA specific barriers included well-documented challenges in successfully implementing weight reduction. Patients reported prior negative experiences including lack of short-term and long-term success with dietary restrictions and physical activity, a belief that weight reduction was not practically possible, lack of long-term support from an HCP, and challenges with behavior modification. HCPs reported difficulty in raising the topic of weight reduction with patients, were concerned about patient comorbid conditions that might influence weight reduction treatment and adherence, and a reciprocal loss of motivation. Lack of access was the fourth theme. Patients reported barriers due to cost of treatment and limitations imposed by insurance providers. HCPs believed that they did not have adequate time to provide effective weight management. HCPs also reported financial factors, lack of patient access to weight management resources, and long waiting times. HCPs also reported a lack of effective obesity treatment options and the difficulty associated with coordinating multimodal care. Conclusion: Despite weight reduction being considered first-line therapy in patients with OA of the knee and obesity, both patients and HCPs reported substantial OA-specific and non-OA specific barriers to achieving weight reduction. Addressing these barriers through the modifications in healthcare education and practice as well as use of emerging anti-obesity medications may improve the success of weight reduction interventions aimed at improving knee OA symptoms and progression. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Philip G. Conaghan AbbVie, Eli Lilly, Novartis, AbbVie, BMS, Eli Lilly, Galapagos, Genascence, GSK, Grunenthal, Janssen, Levicept, Moebius Medical, Novartis, Stryker, Takeda, TrialSpark, Catherine Rolland: None declared, James Frampton: None declared, Louis Lavoie: None declared, Katie Giblin Eli Lilly and Company, Eli Lilly and Company, Rebecca Robinson Eli Lilly and Company, Eli Lilly and Company, Gerhardt Pohl Eli Lilly and Company.