The National Institute for Health and Care Excellence (NICE) has recently proposed an update for the Osteoarthritis: assessment and management guidance (previously published in 2014). The new guidance recommends a significant change in practice which is likely to impact orthotic provision for adults with osteoarthritis. The new guidance recommends the following:
“On considering the evidence identified in this review, the committee agreed that, in general, the evidence for insoles, braces, tape, splints and supports showed no clinically important benefits from their usage when compared to no device use. In some cases, potential harms from the devices were identified (such as blisters with braces). Given this, the committee agreed that based on the absence of strong evidence of benefit and some evidence of harm, that these devices should not be routinely offered”
The statement can be found in “[H] Evidence reviews for the clinical and cost-effectiveness of devices for the management of osteoarthritis” on page 93 lines 33-44.
The British Association of Prosthetists and Orthotists (BAPO) strongly opposes this recommendation. BAPO feels it reduces the service users’ conservative treatment options, particularly where surgery and pharmaceutical intervention is contraindicated.
It is ambiguous in terms of orthotic provision as an adjunct to other interventions e.g., pre-and post-surgery. Similarly, the use of the term “routinely” creates further ambiguity.
BAPO is also disappointed that an orthotist was not included as part of the committee reviewing these guidelines.
BAPO has submitted an official response to the guidance outlining our concerns. We await a response from NICE and will endeavour to keep our members up to date with any progress.