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April 18, 2026Journal of Clinical Medicine0 citationsOpen Access

From Real-World Practice to an Ideal Rehabilitation Pathway in Osteoarthritis: A Delphi Consensus on Patient Itineraries

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HBHelena BascuñanaATAlex Trejo-OmeñacaCCCarlos Cordero-García

Key Points

  • This study aimed to establish a comprehensive and practical rehabilitation pathway for knee osteoarthritis based on expert consensus.
  • Conducted a two-round Delphi study using the SmartDelphi web platform.
  • Developed a 37-item questionnaire covering referral, assessment, management, and discharge.
  • Round 1 involved 40 PM&R physicians providing online feedback.
  • Round 2 included 70 experts validating consensus at an in-person meeting.
  • Consensus strength was evaluated using a Likert scale and interquartile range.
  • Experts agreed on a five-phase function-oriented rehabilitation pathway.
  • Key phases include entry, comprehensive assessment, multimodal conservative rehabilitation, reassessment, and discharge planning.
  • The pathway emphasizes function, conservative care, and structured reassessment.

Abstract

Background: Care for knee osteoarthritis (KOA) is frequently fragmented, and pathway-level decisions within Physical Medicine and Rehabilitation (PM 46 invited, 40 completed; 87.0%) with responses collected until 30 April 2025. Round 2 was an in-person, facilitated validation round on 30 May 2025 at the SERMEF Congress (A Coruña; 85 invited, 70 completed; 82.4%). Items were rated on a 6-point Likert scale; consensus strength was defined by interquartile range (IQR): strong (0–1) vs. weak (≥2). No patient-level data were collected; participant characteristics were comparable across rounds, suggesting consensus refinement reflected deliberation rather than panel shifts over time. Results: Consensus supported a longitudinal, function-first pathway that was structured into five phases: entry/referral to PM comprehensive functional assessment using a minimum outcomes dataset (pain VAS/NRS, WOMAC function, quality-of-life scale); multimodal conservative rehabilitation combining exercise/physiotherapy, education/self-management support, and indicated oral/topical therapies; reassessment-guided escalation in non-responders, reserving interventional PM and longitudinal monitoring with defined discharge criteria. Conclusions: SERMEF PM&R experts converged on an implementation-oriented, outcomes-driven KOA itinerary centred on functioning, conservative multimodal care, structured reassessment, and explicit discharge planning.

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Cite This Study

Bascuñana et al. (2026) studied this question.

synapsesocial.com/papers/69e31f7340886becb653ebe0https://doi.org/10.3390/jcm15083047
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