Researchers have known for more than a decade that exercise relieves pain in people with knee osteoarthritis. There are many studies and the evidence is strong, and when looking back, it was clear in 2002 that adding yet another study would unlikely change the result. Therefore, clinical guidelines all over the world recommend exercise therapy to treat symptoms of osteoarthritis. Despite the mounting research evidence and clinical guidelines recommendations, clinical practice is slow to change and exercise therapy is still greatly underutilised as treatment for people with knee osteoarthritis.

In 2013, a team of researchers at the University of Southern Denmark decided to try a bottom-up approach to implement clinical guidelines for people with knee osteoarthritis in Denmark, a country of 5.5 million people. This not-for-profit model was named Good Life with osteoArthritis in Denmark (GLA:D), and included a two-day course for physiotherapists to get more knowledgeable about osteoarthritis and its treatment options, the delivery of an eight-week combined patient education and exercise therapy treatment program in physiotherapy practice, and the collection of data from before and after the treatment in an electronic registry.

GLA:D has been highly successful as a model to change physiotherapy practice to being in favour of delivering evidence-based treatment. The program is currently available in Canada, Australia, China and Switzerland with New Zealand to follow in late 2019. A similarly structured treatment program has recently been developed for low back pain.

GLA:D benefits patients who experience pain relief, reduced intake of pain killers, improved walking speed and reduced sick leave. In 2019, GLA:D won the Value-Based Health Care Prize in competition with 175- plus international applications from all medical fields with the following motivations:

• proven approach that is being scaled to other countries and for other conditions (eg, back pain)


• allows a patient to take on responsibility for treating the condition


• great example of using therapeutic care rather than drugs or surgery for treating joint pain, and potentially, back pain


• low costs and huge impacts on health system costs.

Physiotherapists and their organisations are encouraged to take on important roles in changing current reimbursement structures to fit with current evidence and thereby facilitate delivery of evidence-based healthcare in physiotherapy practice.

Professor Ewa  Roos has been able to produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities.

What projects are you currently working on to improve sports and exercise physiotherapy?

I am working on several projects at the La Trobe Sport and Exercise Medicine Research Centre that impact on clinical practice for sports and exercise physiotherapy and the health and wellbeing of patients and athletes following knee injury and surgery. My research spans the breadth of injury prevention, optimising rehabilitation following sports-related injury/surgery through to the secondary prevention of knee osteoarthritis and total joint replacement. I currently coordinate a large NHMRC clinical trial (SUPER KNEE) evaluating an exercise-therapy and education intervention to prevent the development of post-traumatic osteoarthritis after ACL injury. I also lead a number of longitudinal cohort studies evaluating risk factors for osteoarthritis and symptomatic development and progression in young adults including an ACL reconstruction cohort that is approaching a 10-year follow- up, and a recreational running cohort following knee surgery.

Can you tell us a bit about what you will be addressing in your presentation?

In my presentation, I will focus on opportunities for sports and exercise physiotherapists to optimise outcomes for individuals following knee injury. In keeping with the TRANSFORM 2019 Conference theme, I will challenge some of the beliefs that exist regarding the need for surgery, re-injury risk and importance of imaging

I will share new data from our research studies, which have identified important modifiable risk factors for the development of early osteoarthritis that can be used to help develop and implement rehabilitation strategies.

What do you hope attendees of your presentation will come away with?

You can expect to come away with new ideas and a greater understanding of how sports-related knee injuries are optimally managed and the importance of functional testing throughout the entire rehabilitation journey. Be prepared to consider a paradigm shift in clinical thinking—from a rehabilitation mindset of rapid return-to-play to one that considers long-term joint health.

Dr Adam Culvenor, APAM, is a NHMRC Research Fellow at the La Trobe Sport and Exercise Medicine Research Centre. Adam’s research focuses on the prevention and management of knee injuries and osteoarthritis over the lifespan.