Knee osteoarthritis is a debilitating condition affecting millions worldwide, often leading to chronic pain and impaired mobility.

Traditionally, many patients have found themselves on long waiting lists for surgery, with limited access to preoperative care that could significantly enhance their recovery and rehabilitation outcomes. 

However, a ground-breaking initiative at Canberra Health Services is transforming the landscape for public system patients. 

By introducing a research-backed conservative management program, this new approach is not only helping to reduce surgical waitlists but also better preparing patients for the challenges of knee surgery recovery.

Central to this initiative are the community care physiotherapists who play a critical role in triaging and screening patients. 

The physiotherapists, led by Judy Stone, ensure that each patient receives the most appropriate care pathway, including the innovative Good Life with OsteoArthritis, Denmark (GLA:D) program for those who may benefit from it. 

The GLA:D program, well- regarded for its evidence-based methods, emphasises education and exercise, offering a proactive approach to managing knee osteoarthritis. 

While it has been available in Canberra through private practice, the ‘GLA:D in the community’ program is the first to offer it to public patients in the ACT.

The positive impacts of this conservative management program are already helping to reshape patient experiences, alleviating the burden on surgical teams and fostering improved outcomes for those facing knee osteoarthritis (OA). 

Through the roles of advanced scope physiotherapists and the implementation of the GLA:D program, the new model of care is promising a brighter future for those with debilitating knee OA.

GLA:D in the community

In Canberra there had been quite a lengthy surgical waitlist for patients with knee OA. 

One of the solutions was to run the GLA:D program out of Canberra Health Services to revise the pathway through the Capital Health Network. 

The idea was to reroute the traditional knee OA pathway of patient to GP, patient undergoes a scan/X-ray and is referred on to surgical consultant for review, then patient is either placed on the elective surgical waiting list or referred elsewhere. 

Instead, patients were referred into the GLA:D in the community program first by their GP, with many opting not to proceed to surgical consultation afterwards while others already on the elective surgical waiting list had the benefit of the program in the preoperative phase, to better assist in the postsurgical recovery phase.

‘We’ve always done rehab programs for people after their surgery and we’ve always done prehab programs to get people prepared for surgery. 

'But to my knowledge there has never been one program that is evidence-based, that is across the nation, and is consistent in its delivery. 

'I think the GLA:D program is the first in that,’ Judy says.

‘It was in June 2021 that I rolled it out the GLA:D program, initially just as a 12-month pilot project just to see how it went. 

'It went so well that even the [ACT] Health Minister [Rachel Stephen-Smith] was pleased with it. 

'She agreed to fund some physio positions for me and an administrative position. 

'She gave me funding for two HP3 physios and one administrative, all full-time. 

'Because the pilot had been so successful and everyone could see that this was a really good idea, we got funding to keep the program running permanently in the community.’

Judy says the feedback from the patients has been overwhelmingly in favour of the program. 

‘Patients were saying things like “I wish I’d known about this earlier because my pain is gone and now I’m able to do all the things I wanted to do, so I’m going to take myself off the surgical waiting list because I don’t need the operation, I just need to keep doing these exercises.” 

'It was feedback like that that was making us think “Ooh, this is going to work”.’

The physiotherapy-led program also includes the services of a dietitian (‘weight management has been shown to be absolutely essential in conservative management of OA’), Judy says. 

Patients aged in their 40s up to their 90s have been referred into the GLA:D in the community program. 

The program runs for six weeks and patients attend twice weekly sessions, or one a week for 12 weeks if they are unable to attend twice weekly. 

The program also includes two education components that can be delivered online or face-to-face.

‘The education component is a big factor in its success because without the education, people have this concept of arthritis as being totally irreversible and there’s nothing they can do. 

'We can educate them and say to them “Look, we can’t replace your cartilage back to how it was when you were 20, but we can get the blood flow going to a sufficient level to make you pain-free if you do the work towards it”,’ Judy says. 

‘Patients are blown away by it. They’re always saying to me “I wish I’d known this 20 years ago”.

‘The patients also really enjoy the social experience of it. 

A number of times, after I’ve done the GLA:D and I’ve nipped over the road for a coffee, I see a whole group of them all sitting around having a coffee, all talking about their experiences and their healthcare journey. 

It’s lovely. It’s really nice to see that element coming out of it.’

Judy and her team are engaged in the process of reaching out to all of the participants in the GLA:D in the community program as well as those currently on the surgical waitlist to make sure they are offered the same access.

‘We need to follow up with these patients to find out if they’ve had their surgery and if they did have their surgery, was their recovery improved by having done the GLA:D program? 

'That is a project for the future,’ Judy says.

Running concurrently with the GLA:D in the community program is the research program ‘best practice knee osteoarthritis— embedding advanced physiotherapy in orthopaedic screening’, headed by Jennie Scarvell APAM, a physiotherapist researcher and deputy dean at the University of Canberra.

This two-year research program is run through the University of Canberra and funded through private health insurer HCF’s
Translation Grant, to research the knee OA pathway. 

The research program is run in collaboration with Canberra Health Services with cooperation from advance scope physiotherapists and the orthopaedic surgery team. 

Jennie is the chief investigator on a team of 12 investigators on the program, which is deeply embedded with the orthopaedic surgery team at Canberra Hospital.

While the community and the research programs are run separately, each has the same goal—making sure that people with knee osteoarthritis get the non-surgical interventions they need.

Next month: A look inside the knee OA research program with Professor Jennie Scarvell and The University of Canberra.