India-Based Knee Osteoarthritis Evaluation (iKare): A Multi-Centre Cross-Sectional Study on the Management of Knee Pain and Early Osteoarthritis in India

BACKGROUND: Access to early knee osteoarthritis treatment in low and middle income nations is often believed to be limited. We conducted a cross-sectional study in India to assess prior access to treatment among patients presenting with knee pain to specialist orthopaedic clinics. METHODS: The multi-centre, cross-sectional study included patients presenting with knee pain at 3 hospitals in India. Patients who met the inclusion criteria and provided informed consent completed a questionnaire designed to assess patient demographics, socioeconomic status, knee pain, treatment method, and patient's knowledge on osteoarthritis (OA). Their orthopaedic surgeons also completed a questionnaire on the severity of patient's OA and their recommended treatments. The impact of demographic characteristics on the prescription of treatment options was analyzed using logistic regression. RESULTS: A total of 714 patients met the eligibility criteria and participated in this study. The majority of patients had been experiencing pain for less than 1 year (64.8%) and had previously been prescribed medications (91.6%), supplements (68.6%), and nonpharmacological (81.9%) treatments to manage their knee OA. Current treatment recommendations included oral medications (83.3%), intra-articular injections (29.8%), and surgical intervention (12.7%). Prescription of oral medications was related to younger age, lack of deformities, and lower Kellgren-Lawrence grades (p < 0.01). Patients treated in private hospital settings were more likely to have been previously treated with medications (range, 84.3% to 92.6%; p < 0.01) and physical treatments (range, 61.8% to 84.8%; p < 0.01) than patients treated at government hospitals. CONCLUSIONS: Contrary to the perception, our findings suggest a similar proportion of early knee OA treatment between India and North America.

Common pitfalls in the conduct of clinical research

Recently, paradigm shift from expert opinion towards evidence-based medicine has occurred encouraging physicians to base their treatment decisions on the best available research evidence. In the hierarchy of evidence randomized clinical trials [level 1 evidence] are considered of the highest quality [least biased] while non-randomized studies represent lower levels [levels 2-4]. Several pitfalls in the design and conduct of clinical research include: lack of randomization, lack of concealment, lack of blinding, and errors in hypothesis testing [type I and II errors]. A basic understanding of these principles of research will empower both investigators and readers when applying the results of research to clinical practice