Appendix Table 2.

Provider Intervention Recommendations and Algorithms

Criteria to refer to physical therapy for evaluation and/or therapeutic exercises

Patient may be interested in being referred for physical therapy for OA if his or her provider recommends, and

Patient is not doing lower-extremity strengthening exercises ≥2 times per week, and

Patient indicates being dissatisfied with his or her ability to perform one or more activities on the Satisfaction with Physical Function Scale (walking, lifting/carrying, stair climbing, and housework), and

Patient has not seen a physical therapist for his or her OA in the past year.

Criteria to refer for evaluation for knee brace*

Patient is not currently using a knee brace, and

Patient may be interested in trying a knee brace (or different kind of knee brace) if his or her provider recommends.

Criteria to refer to weight management program

Patient has a BMI ≥ 25 kg/m2, and

Patient may be interested in being referred to a weight management program if his or her provider recommends.

Criteria to refer to physical activity program

Patient is not doing at least 2 h and 30 min of aerobic activity per week and strengthening exercises ≥ 2 times per week, and

Patient may be interested in being referred to a physical activity program if his or her provider recommends.

Criteria to perform or refer for intra-articular knee injection

Patient has moderate to severe knee pain (≥ 6 on a 10-cm visual analog scale), and

Patient has radiographic evidence of OA in that knee, and

Patient is already taking oral pain medications, and

Patient has not received a joint injection in the past 6 mo, and

Patient may be interested in having a knee joint injection if his or her provider recommends.

Criteria to perform or refer for intra-articular hip injection

Patient has moderate to severe hip pain (≥ 6 on a 10-cm visual analog scale), and

Patient has radiographic evidence of OA in that hip, and

Patient is already taking oral pain medications, and

Patient has not received a hip joint injection in the past 6 mo, and

Patient may be interested in having a hip joint injection if his or her provider recommends.

Criteria to recommend or prescribe topical NSAID or capsaicin

Patient is not currently using topical creams for OA, and

Patient may be interested in trying a topical cream (or different type of topical cream) if his or her provider recommends.

Patient reports taking an NSAID (prescription or over-the-counter) but has risk factors for gastrointestinal bleeding. Criteria to consider addition of gastroprotective agent or switch to other pain medication

Patient is currently using an NSAID without gastroprotective agent, and

Patient has ≥ 1 risk factor for gastrointestinal bleeding: age ≥ 75 y, history of peptic ulcer disease or gastrointestinal bleeding, and current glucocorticoid use.

Criteria to discuss the possibility of trying a new/alternate pain medication with patient

Patient indicated he or she may like to talk with his or her health care provider about the possibility of trying a different pain medication for his or her arthritis.

Criteria for referral to orthopedics for evaluation for joint replacement surgery (if no contraindications to surgery)

Radiographic evidence of OA in that joint, and

Patient has tried each of the following: pain medications, joint injection, and physical therapy, and

Pain ≥ 6 (on a 10-cm visual analog scale) in that joint, and

Functional limitation due to OA ≥ 6 (on a 10-point visual numeric scale), and

Patient indicated he or she may be interested in being referred to a specialist for evaluation for potential joint replacement surgery.

BMI = body mass index; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis.

^*For each knee with OA.