The clinical profile of individuals with symptoms of knee osteoarthritis referred to secondary care in Denmark: A cross-sectional study of 282 people

Osteoarthritis (OA) is a leading global contributor to years lived with disability and accounts for the largest global increase in years lived with disability during the past 30 years among musculoskeletal conditions (Cieza et al., 2020). International guidelines recommend exercise therapy alongside patient education and weight management (if needed) as first-line treatment for all individuals with knee OA (KOA) (Bannuru et al., 2019). However, clinical care pathways for KOA do not seem to reflect these recommendations and community-based OA care is generally of suboptimal quality (Hagen et al., 2016). This is mirrored in a Danish health care setting, where only about 1/3 of patients who were referred to an orthopaedic assessment in secondary care (the hospital) had received exercise therapy and patient education during the preceding year in the period March 2018 to February 2019 (Ingelsrud et al., 2020). These numbers give reasons to believe that a substantial part of the current KOA waiting lists for orthopaedic assessment in secondary health care is comprised of inappropriate referrals (Mikkelsen et al., 2019), that is, artificially inflating waiting lists and wasting both the patient's and the orthopaedic surgeon's time in an inefficient use of the scarce resources in secondary health care. These scarce resources in secondary health care were evident during the extraordinary events of the COVID-19 pandemic, which created a big backlog of KOA patients waitlisted for orthopaedic assessment in secondary health care around Europe (Hampton et al., 2021; Uimonen et al., 2021). In Denmark, this led to a COVID-19 enforced initiative at one public hospital, introducing orthopaedic assessments by specially trained physiotherapists to reduce waiting lists and provide quicker referrals to appropriate KOA care. Using data from this clinical initiative, this report aims to describe patient and clinical characteristics along with patients' treatment preferences and expectations of treatment outcomes among wait-listed KOA patients to better understand referral patterns and health care seeking behaviour in current clinical KOA practice in Denmark.