Osteoarthritis

by | 08/07/2025

Risk

  • Osteoarthritis (OA) involves the gradual degeneration of cartilage in the joints can cause pain, stiffness, and difficulty moving the joints. It is the most common type of arthritis in the UK.

Reason

  • If joint movement is inhibited, for example if the knees are not able to bend enough for a sit to stand, or if the shoulders are too painful when using the upper limbs to push up on the arms of the chair, the resulting lack of mobility practice will mean that the person is more likely to fall when they do mobilise.
  • Also, if the joints of the lower limb are affected, and painful whilst walking, (e.g. the hips, knees, ankles or feet), there is a greater risk of falling.
  • Individuals living with OA may avoid moving the affected area, even when sedentary, which is likely to lead to muscle weakness, poorer function, and worsened balance.

Interventions

  • A referral can be made to a qualified Physiotherapist who can do an assessment, and give prescribed exercises that are appropriate for the person, and which will aim to encourage movement of their joints. It may however be better to refer the person to their GP so that they can order the appropriate investigations, and refer to a Physiotherapist as they deem necessary. It is always advisable to make the referral as specific as possible, for example, if the individual has recently become less able to perform a certain functional task (particularly if this presents an increased risk to the person), explaining this is useful information for the person receiving the referral to ascertain how urgent the person needs to be seen.
  • Ensure that the person is taking any prescribed medication for inflammation and/or pain. This may ease joint movements, particularly before physical activity.
  • Be aware of the person’s posture and joint alignment, both on sitting and in lying. A symmetrical alignment of the pelvis is important to avoid joints being in a ‘twisted’ position. Support joints to be in good alignment where possible, for example, a pillow between the knees and ankles when side-lying in bed, keeps the knees and ankles in line with the hips, therefore prevents stress at the hips and knees.
  • Ensure that individuals with OA move regularly, so that they do not remain in one position for too long. Movement often helps to reduce stiffness.
  • If the person’s symptoms are slightly different, this may indicate another joint condition. For example, prolonged joint stiffness in the morning can be a sign of rheumatoid arthritis (RA). Report any such changes to the GP.
  • Use an enabling approach to encourage improved independence during Activities of Daily Living (ADLs).
  • Encourage movement wherever possible, within each person’s individual fitness/capability level. This may mean assisting with hourly sit to stand practice, encouraging a person to mobilise to the toilet (rather than been taken in a wheelchair), or encouraging participation in an exercise class, such a Chair-Based Exercise or Strength and Balance Exercise.
  • Ensure you have members of staff who are trained in Chair-Based Exercise and Strength and Balance Exercise, so that you can offer in- house classes.
  • Use the HCPA recommended exercises for individuals on a 1:1 basis and ensure that you complete a risk assessment and put in place any interventions that help minimise any risk of falls/injury to the person (you do not have to be a trained instructor to do these recommended exercises on a 1:1 basis).
    • Always refer to a qualified Physiotherapist for advice on which specific exercises may be appropriate for the person, if you or they have any concerns with the HCPA recommended exercises.
    • Report immediately to the GP if the person is experiencing worsened pain after performing a new exercise.
    • Always refer to a qualified Physiotherapist for advice on which specific exercises may be appropriate for the person, if you or they have any concerns with the HCPA recommended exercises.
  • Encourage individuals to gradually build up their physical activity levels, aiming for 150 minutes of moderate aerobic activity every week (30 mins per day for 5 days of the week), plus strength and balance exercises that work the major muscle groups on 2 days per week. Ensure that individuals are aware that they may need to avoid exercises that put too much strain on their painful joints.
  • Build activity/exercise up gradually, using step-by-step goals.

Considerations

  • It is important that the individual’s capacity to make decisions around each specific area is considered and documented.
  • Individuals who have capacity regarding these decisions can make choices about what they want to do and about which strategies they do, or do not, wish to be implemented. You need to document their ability to make this decision, as well as what they chose every time is it relevant.
  • You may need to inform them of the benefits and risks, if they are not aware, or you may need to remind them if they have difficulty remembering things.
  • If the individual is assessed as not having capacity regarding a decision, this needs to be documented appropriately and interventions need to be implemented and documented as part of a Best Interests Decision, using appropriate paperwork.