What non-pharmacological interventions should I advise for patients wi

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

For patients with osteoarthritis, you should advise on several non-pharmacological interventions:

Offer therapeutic exercise tailored to their needs, such as local muscle strengthening and general aerobic fitness, for all people with osteoarthritis ,,.
Consider supervised therapeutic exercise sessions ,.
Advise patients that joint pain may initially increase when starting therapeutic exercise, but regular and consistent exercise will be beneficial for their joints, reducing pain and increasing functioning and quality of life long-term ,.
Consider combining therapeutic exercise with an education programme or behaviour change approaches in a structured treatment package .
Referral to a musculoskeletal first contact practitioner may be considered to support this approach .
The Versus Arthritis online 12-week programme 'Let's Move with Leon' may also be helpful .

For patients living with overweight or obesity, advise that weight loss will improve their quality of life and physical function, and reduce pain ,.
Support them to choose a weight loss goal and explain that any amount of weight loss is likely to be beneficial, with losing 10% of body weight being better than 5% .

Offer an individualized management plan based on the person's symptoms, affected joints, physical function, and comorbidities .
Advise on sources of information and support, such as Versus Arthritis, NHS/Versus Arthritis decision support tools, and NHS information leaflets .
Advise on self-care strategies for symptom relief, including for flares .
Advise on wearing appropriate footwear if needed .

Only consider manual therapy (e.g., manipulation, mobilisation, or soft tissue techniques) for people with hip or knee osteoarthritis, and only alongside therapeutic exercise .
Explain that there is insufficient evidence to support its use alone for managing osteoarthritis .

Consider walking aids (such as walking sticks) for people with lower limb osteoarthritis .
Do not routinely offer insoles, braces, tape, splints, or supports unless there is joint instability or abnormal biomechanical loading, therapeutic exercise is ineffective or unsuitable without the aid, and the aid is likely to improve movement and function .
Assistive devices and adaptations at home or work are recommended by the European League Against Rheumatism (EULAR) .
Consider seeking expert advice from an occupational therapist or Disability Equipment Assessment Centre for assistive devices .

Offer psychosocial support if needed, including support for associated stress, anxiety, or depression .
Signpost for an Adult social care and/or carer assessment and/or to a social prescribing link worker if needed .
Signpost for an Occupational Health assessment to assess workplace risk and modification of duties, hours, and work environment, if needed .

Do not offer acupuncture or dry needling to manage osteoarthritis ,.
Do not offer electrotherapy treatments such as transcutaneous electrical nerve stimulation (TENS), ultrasound therapy, interferential therapy, laser therapy, pulsed short-wave therapy, or neuromuscular electrical stimulation (NMES) due to insufficient evidence of benefit .
Do not recommend the use of chondroitin or glucosamine .
Do not offer intra-articular hyaluronan injections .

What non-pharmacological interventions should I advise for patients with osteoarthritis?