Quality standard
Quality statement 4: Therapeutic exercise
Quality statement 4: Therapeutic exercise
Rationale
Therapeutic exercise is a core treatment for osteoarthritis that will help manage and reduce symptoms and improve or maintain physical function. It is important that people are advised to undertake specific exercise that is relevant for their condition, and that it is tailored to their needs, for example, muscle strengthening that targets affected joints and general aerobic fitness. Healthcare professionals will need to make a judgement about the best way to support people to exercise, because this will vary for each person depending on their needs, circumstances and self‑motivation, and may change over time.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults with osteoarthritis are advised to do tailored therapeutic exercise.
Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications.
Process
a) Proportion of adults newly diagnosed with osteoarthritis who receive advice on tailored therapeutic exercise.
Numerator – the number in the denominator who receive advice on tailored therapeutic exercise.
Denominator – the number of adults newly diagnosed with osteoarthritis.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
b) Proportion of adults with osteoarthritis who receive advice to do tailored therapeutic exercise at their follow-up appointment.
Numerator – the number in the denominator who receive advice to do tailored therapeutic exercise.
Denominator – the number of adults with osteoarthritis attending a follow-up appointment.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
a) Physical activity in adults with osteoarthritis.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
b) Patient satisfaction with advice on exercise.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient surveys.
What the quality statement means for different audiences
Service providers (GPs and community healthcare providers) ensure that processes are in place so that adults with osteoarthritis are advised to do therapeutic exercise tailored to their needs, such as local muscle strengthening and general aerobic fitness. Advice is given at both diagnosis and follow-up appointments. Service providers may compile information about local exercise classes, groups and facilities, so that people can be given information about any that are suitable.
Healthcare professionals ensure that they advise adults with osteoarthritis at both diagnosis and follow-up appointments to do therapeutic exercise. This is tailored to the person's needs, and may involve local muscle strengthening and general aerobic fitness, and information on suitable local exercise classes, groups and facilities.
Commissioners ensure that they commission services in which adults with osteoarthritis are advised at both diagnosis and follow-up appointments to do therapeutic exercise which is tailored to their needs, such as local muscle strengthening and general aerobic fitness.
Adults with osteoarthritis are advised by their healthcare professional to exercise to strengthen the muscles that support their affected joints and help to improve their symptoms. The exercises are tailored to the person's needs and preferences, and may involve exercises to do at home or joining a local exercise class.
Source guidance
Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226 (2022), recommendations 1.2.2, 1.3.1 and 1.3.2
Definitions of terms used in this quality statement
Tailored therapeutic exercise
Exercise tailored to the needs of adults with osteoarthritis, such as local muscle strengthening and general aerobic fitness, to reduce their symptoms and improve or maintain physical functioning over the long term.
Therapeutic exercise should be offered to adults with newly diagnosed osteoarthritis and at follow-up appointments, along with information and support. [Adapted from NICE's guideline on osteoarthritis in over 16s, recommendation 1.3.1, rationale and impact section; and expert opinion]
Equality and diversity considerations
Healthcare professionals should take into account cultural and communication needs (including any learning disabilities) when providing information and support for adults with osteoarthritis. This should include providing printed information for people who cannot access information online and providing information in accessible large print and easy read formats where needed. For adults with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.
All adults with osteoarthritis should be encouraged to exercise. If age, comorbidities, pain severity or disability are seen as a barrier, the person may need specific advice and support, such as offering supervised therapeutic exercise, to encourage participation, and should be advised that exercise may improve their symptoms.