From Real-World Practice to an Ideal Rehabilitation Pathway in Osteoarthritis : A Delphi Consensus on Patient Itineraries
Bascuñana, Helena (Institut de Recerca Sant Pau)
Trejo-Omeñaca, Alex (Universitat Politècnica de Catalunya)
Cordero-García, Carlos (Hospital Universitario Juan Ramón Jiménez)
Fuertes-González, Sergio (Hospital Santiago Apostol)
Castillo-Martín, Juan Ignacio (Hospital Universitario 12 de Octubre (Madrid))
Catta-Preta, Michelle (Innex Labs)
Ferrer-Picó, Jan (Universitat Politècnica de Catalunya)
Monguet-Fierro, Josep Maria (Universitat Politècnica de Catalunya)
Formigo-Couceiro, Jacobo (Hospital Universitario de A Coruña)
Universitat Autònoma de Barcelona. Departament de Medicina

Date:	2026
Abstract:	Background: Care for knee osteoarthritis (KOA) is frequently fragmented, and pathway-level decisions within Physical Medicine and Rehabilitation (PM&R) are influenced by local organizations. The objective of this study was to identify areas of agreement and disagreement among PM&R experts and to translate these into a clinically interpretable, function-oriented care pathway for knee osteoarthritis (KOA) within rehabilitation services. Methods: A two-round Real-Time Delphi study was conducted using the SmartDelphi web platform. A steering committee of five PM&R physicians developed a 37-item questionnaire covering referral/access, functional and outcome assessment, conservative management, escalation/referral thresholds, and follow-up/discharge. Round 1 was online (SERMEF osteoarthritis working group; 46 invited, 40 completed; 87. 0%) with responses collected until 30 April 2025. Round 2 was an in-person, facilitated validation round on 30 May 2025 at the SERMEF Congress (A Coruña; 85 invited, 70 completed; 82. 4%). Items were rated on a 6-point Likert scale; consensus strength was defined by interquartile range (IQR): strong (0-1) vs. weak (≥2). No patient-level data were collected; participant characteristics were comparable across rounds, suggesting consensus refinement reflected deliberation rather than panel shifts over time. Results: Consensus supported a longitudinal, function-first pathway that was structured into five phases: entry/referral to PM&R; comprehensive functional assessment using a minimum outcomes dataset (pain VAS/NRS, WOMAC function, quality-of-life scale); multimodal conservative rehabilitation combining exercise/physiotherapy, education/self-management support, and indicated oral/topical therapies; reassessment-guided escalation in non-responders, reserving interventional PM&R techniques, multidisciplinary musculoskeletal pain-unit management, or orthopedic evaluation for persistent pain and/or functional limitation; and longitudinal monitoring with defined discharge criteria. Conclusions: SERMEF PM&R experts converged on an implementation-oriented, outcomes-driven KOA itinerary centred on functioning, conservative multimodal care, structured reassessment, and explicit discharge planning.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Knee osteoarthritis ; Physical medicine and rehabilitation ; Delphi consensus ; Real-time Delphi; ; Care pathway ; Rehabilitation itinerary
Published in:	Journal of clinical medicine, Vol. 15, Num. 8 (April 2026) , art. 3047, ISSN 2077-0383

DOI: 10.3390/jcm15083047
PMID: 42074847

17 p, 2.8 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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