What non-pharmacological interventions should I advise for patients with osteoarthritis to improve their quality of life?

Non-pharmacological interventions for patients with osteoarthritis to improve quality of life include:

• Therapeutic exercise: Offer tailored therapeutic exercise such as local muscle strengthening and general aerobic fitness to all patients with osteoarthritis. Supervised exercise sessions may be considered to enhance adherence and benefits. Patients should be advised that initial joint pain may increase but regular exercise reduces pain and improves function and quality of life in the long term.
• Weight management: For patients who are overweight or obese, advise weight loss to improve quality of life, physical function, and reduce pain. Support patients in setting weight loss goals, noting that losing 10% of body weight is more beneficial than 5%, but any weight loss is helpful.
• Manual therapy: Consider manual therapy (manipulation, mobilisation, soft tissue techniques) only alongside therapeutic exercise for hip or knee osteoarthritis, explaining that manual therapy alone lacks sufficient evidence.
• Walking aids: Consider walking aids such as sticks or frames for people with lower limb osteoarthritis to improve mobility, balance, and reduce joint load.
• Education and behaviour change: Combine therapeutic exercise with education programmes or behaviour change approaches, including pain coping skills, goal setting, motivational coaching, and workplace risk counselling, to support self-management.
• Self-care strategies and patient information: Provide clear, evidence-based patient information and encourage peer support to reduce isolation and improve self-management.

Interventions not recommended: Do not offer acupuncture, dry needling, electrotherapy (e.g., TENS, ultrasound), insoles, braces, tape, splints, or supports routinely unless specific indications exist. Avoid routine use of topical rubefacients and local anaesthetics.

These non-pharmacological approaches should be the foundation of osteoarthritis management to improve quality of life and physical function, ideally before considering pharmacological or surgical options.

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